Cancer-specific and other-cause mortality after radical prostatectomy versus observation in patients with prostate cancer: competing-risks analysis of a large North American population-based cohort |
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Authors: | Abdollah Firas Sun Maxine Schmitges Jan Tian Zhe Jeldres Claudio Briganti Alberto Shariat Shahrohk F Perrotte Paul Montorsi Francesco Karakiewicz Pierre I |
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Institution: | a Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada b Department of Urology, Vita Salute San Raffaele University, Milan, Italy c Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany d Department of Urology, Weill Medical College of Cornell University, New York, NY, USA e Department of Urology, University of Montreal Health Center, Montreal, Canada |
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Abstract: | BackgroundInitial treatment options for low-risk clinically localized prostate cancer (PCa) include radical prostatectomy (RP) or observation.ObjectiveTo examine cancer-specific mortality (CSM) after accounting for other-cause mortality (OCM) in PCa patients treated with either RP or observation.Design, setting, and participantsUsing the Surveillance Epidemiology and End Results Medicare-linked database, a total of 44 694 patients ≥65 yr with localized (T1/2) PCa were identified (1992-2005).InterventionRP and observation.MeasurementsPropensity-score matching was used to adjust for potential selection biases associated with treatment type. The matched cohort was randomly divided into the development and validation sets. Competing-risks regression models were fitted and a competing-risks nomogram was developed and externally validated.Results and limitationsOverall, 22 244 (49.8%) patients were treated with RP versus 22450 (50.2%) with observation. Propensity score-matched analyses derived 11 669 matched pairs. In the development cohort, the 10-yr CSM rate was 2.8% (2.3-3.5%) for RP versus 5.8% (5.0-6.6%) for observation (absolute risk reduction: 3.0%; relative risk reduction: 0.5%; p < 0.001). In multivariable analyses, the CSM hazard ratio for RP was 0.48 (0.38-0.59) relative to observation (p < 0.001). The competing-risks nomogram discrimination was 73% and 69% for prediction of CSM and OCM, respectively, in external validation. The nature of observational data may have introduced a selection bias.ConclusionsOn average RP reduces the risk of CSM by half in patients aged ≥65 yr, relative to observation. The individualized protective effect of RP relative to observation may be quantified with our nomogram. |
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Keywords: | Prostate cancer Cancer-specific mortality Other-cause mortality Competing-risks regression Nomogram |
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