A 25-year Period Analysis of Other-cause Mortality in Localized Prostate Cancer

TY - JOUR

T1 - A 25-year Period Analysis of Other-cause Mortality in Localized Prostate Cancer

AU - Knipper, Sophie

AU - Pecoraro, Angela

AU - Palumbo, Carlotta

AU - Rosiello, Giuseppe

AU - Luzzago, Stefano

AU - Tian, Zhe

AU - Briganti, Alberto

AU - Saad, Fred

AU - Tilki, Derya

AU - Graefen, Markus

AU - Karakiewicz, Pierre I

N1 - Copyright © 2019 Elsevier Inc. All rights reserved.

PY - 2019/10

Y1 - 2019/10

N2 - BACKGROUND: We examined the changes over time in other-cause mortality (OCM) rates in patients with clinically localized prostate cancer (PCa) as an indicator of patient selection.PATIENTS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (1987-2011), we identified patients with PCa treated with either radical prostatectomy (RP) (n = 230,969; 62.8%) or external beam radiation therapy (EBRT) (n = 136,915; 37.2%). Temporal trends and multivariable Cox regression analyses assessed OCM at 5 years using stratification according to year of diagnosis (1987-1991 vs. 1992-1996 vs. 1997-2001 vs. 2002-2006 vs. 2007-2011), age group, and ethnicity.RESULTS: In patients who had undergone RP, the OCM rates at 5 years of follow-up decreased over time from 7.9% to 2.4% (slope, -0.25%/year) versus from 15.2% to 9.9% after EBRT (slope, -0.29%/year). The greatest decrease in 5-year OCM rates over time was recorded in patients ≥ 75 years (16.0%-12.0%; slope, -0.25%/year), followed by younger age categories (70-74 years, -0.21%/year; 65-69 years, -0.17%/year; 60-64 years, -0.10%/year; < 60 years, -0.07%/year), as well as in African-American men (11.0%-5.1%; slope, -0.32%/year), followed by Caucasian (7.6%-3.4%; slope, -0.21%/year) and Hispanic men (7.0%-3.1%; slope, -0.20%/year; all P < .001), as corroborated in multivariable Cox regression models.CONCLUSIONS: OCM rates were highest in oldest individuals and in African-American men. In both groups, an important 5-year OCM reduction over the 25-year study span was recorded. Nonetheless, these 2 patient groups may still represent the ideal target for better patient selection based on OCM considerations, because their most recent OCM rates exceeded those of, respectively, younger and Caucasian patients.

AB - BACKGROUND: We examined the changes over time in other-cause mortality (OCM) rates in patients with clinically localized prostate cancer (PCa) as an indicator of patient selection.PATIENTS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (1987-2011), we identified patients with PCa treated with either radical prostatectomy (RP) (n = 230,969; 62.8%) or external beam radiation therapy (EBRT) (n = 136,915; 37.2%). Temporal trends and multivariable Cox regression analyses assessed OCM at 5 years using stratification according to year of diagnosis (1987-1991 vs. 1992-1996 vs. 1997-2001 vs. 2002-2006 vs. 2007-2011), age group, and ethnicity.RESULTS: In patients who had undergone RP, the OCM rates at 5 years of follow-up decreased over time from 7.9% to 2.4% (slope, -0.25%/year) versus from 15.2% to 9.9% after EBRT (slope, -0.29%/year). The greatest decrease in 5-year OCM rates over time was recorded in patients ≥ 75 years (16.0%-12.0%; slope, -0.25%/year), followed by younger age categories (70-74 years, -0.21%/year; 65-69 years, -0.17%/year; 60-64 years, -0.10%/year; < 60 years, -0.07%/year), as well as in African-American men (11.0%-5.1%; slope, -0.32%/year), followed by Caucasian (7.6%-3.4%; slope, -0.21%/year) and Hispanic men (7.0%-3.1%; slope, -0.20%/year; all P < .001), as corroborated in multivariable Cox regression models.CONCLUSIONS: OCM rates were highest in oldest individuals and in African-American men. In both groups, an important 5-year OCM reduction over the 25-year study span was recorded. Nonetheless, these 2 patient groups may still represent the ideal target for better patient selection based on OCM considerations, because their most recent OCM rates exceeded those of, respectively, younger and Caucasian patients.

KW - Age Factors

KW - Aged

KW - Combined Modality Therapy

KW - Ethnic Groups/statistics & numerical data

KW - Follow-Up Studies

KW - Healthcare Disparities

KW - Humans

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Prostatectomy/statistics & numerical data

KW - Prostatic Neoplasms/mortality

KW - Radiotherapy, Intensity-Modulated/statistics & numerical data

KW - Retrospective Studies

KW - Risk Factors

KW - SEER Program

KW - Survival Rate

KW - United States/epidemiology

U2 - 10.1016/j.clgc.2019.07.008

DO - 10.1016/j.clgc.2019.07.008

M3 - SCORING: Journal article

C2 - 31416752

VL - 17

SP - 395

EP - 401

JO - CLIN GENITOURIN CANC

JF - CLIN GENITOURIN CANC

SN - 1558-7673

IS - 5

ER -