Journal article
Effect of Age, Tumor Risk, and Comorbidity on Competing Risks for Survival in a U.S. Population―Based Cohort of Men With Prostate Cancer
Annals of internal medicine, Vol.158(10), pp.709-717
2013
DOI: 10.7326/0003-4819-158-10-201305210-00005
PMCID: PMC3760479
PMID: 23689764
Abstract
Background: Accurate estimation of life expectancy is essential to offering appropriate care to men with early-stage prostate cancer, but mortality risks associated with comorbidity are poorly defined.
Objective: To determine the effect of age, comorbidity, and tumor risk on other-cause and prostate cancer-specific mortality in men with early-stage disease.
Design: Prospective cohort study.
Setting: A nationally representative, population-based cohort.
Patients: 3183 men with nonmetastatic prostate cancer at diagnosis.
Measurements: Baseline self-reported comorbidity (scored as a count of 12 major comorbid conditions), tumor characteristics, initial treatment, and overall and disease-specific mortality through 14 years of follow-up. Survival analyses that accounted for competing risks were performed.
Results: Fourteen-year cumulative other-cause mortality rates were 24%, 33%, 46%, and 57% for men with 0, 1, 2, and 3 or more comorbid conditions, respectively. For men diagnosed at age 65 years, subhazard ratios for other-cause mortality among those with 1, 2, or 3 or more comorbid conditions (vs. none) were 1.2 (95% CI, 1.0 to 1.4), 1.7 (CI, 1.4 to 2.0), and 2.4 (CI, 2.0 to 2.8), respectively. Among men with 3 or more comorbid conditions, 10-year other-cause mortality rates were 26%, 40%, and 71% for those aged 60 years or younger, 61 to 74 years, and 75 years or older at diagnosis, respectively. Prostate cancer-specific mortality was minimal in patients with low-risk (3%) and intermediate-risk (7%) disease but appreciable in those with high-risk disease (18%) and did not vary by number of comorbid conditions (10% to 11% in all groups).
Limitation: Comorbid conditions were self-reported.
Conclusion: Older men with multiple major comorbid conditions are at high risk for other-cause mortality within 10 years of diagnosis and should consider this information when deciding between conservative management and aggressive treatment for low- or intermediate-risk prostate cancer.
Details
- Title: Subtitle
- Effect of Age, Tumor Risk, and Comorbidity on Competing Risks for Survival in a U.S. Population―Based Cohort of Men With Prostate Cancer
- Creators
- Timothy J DASKIVICH - University of California, Los Angeles, California, United StatesKang-Hsien FAN - University of California, Los Angeles, California, United StatesDavid F PENSON - University of California, Los Angeles, California, United StatesTatsuki KOYAMA - University of California, Los Angeles, California, United StatesPeter C ALBERTSEN - University of California, Los Angeles, California, United StatesMichael GOODMAN - University of California, Los Angeles, California, United StatesAnn S HAMILTON - University of California, Los Angeles, California, United StatesRichard M HOFFMAN - University of California, Los Angeles, California, United StatesJanet L STANFORD - University of California, Los Angeles, California, United StatesAntoinette M STROUP - University of California, Los Angeles, California, United StatesMark S LITWIN - University of California, Los Angeles, California, United States
- Resource Type
- Journal article
- Publication Details
- Annals of internal medicine, Vol.158(10), pp.709-717
- DOI
- 10.7326/0003-4819-158-10-201305210-00005
- PMID
- 23689764
- PMCID
- PMC3760479
- NLM abbreviation
- Ann Intern Med
- ISSN
- 0003-4819
- eISSN
- 1539-3704
- Publisher
- American College of Physicians
- Language
- English
- Date published
- 2013
- Academic Unit
- Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984094568602771
Metrics
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