Journal article
The Impact of Local Treatment on Overall Survival in Patients with Metastatic Prostate Cancer on Diagnosis: A National Cancer Data Base Analysis
European urology, Vol.72(1), pp.14-19
07/01/2017
DOI: 10.1016/j.eururo.2016.04.031
PMID: 27174537
Abstract
The role of local treatment (LT) in patients with metastatic prostate cancer (mPCa) at diagnosis is controversial.
We set to evaluate the potential impact of LT on overall mortality (OM) in men with mPCa, and how this impact is influenced by tumor and patient characteristics.
A total of 15 501 patients with mPCa were identified in the National Cancer Data Base (2004–2012) and categorized in LT (radical prostatectomy or radiation therapy targeted to prostate) versus nonlocal treatment (NLT; all other patients).
The two arms (LT vs NLT) were matched using propensity scores to minimize selection bias. To evaluate LT impact on OM in relation to baseline characteristics, first multivariable Cox regression analysis was used to predict OM in patients treated with NLT, then interaction between predicted OM risk and LT status was tested.
Overall, 9.5% (n=1470) of patients received LT. In the postpropensity matched cohorts, 3-yr OM-free survival was higher in the LT group versus the NLT group (69% vs 54%; p<0.001). In multivariable Cox regression, the NLT group, age, and Charlson comorbidity index were predictors of OM (all p≤0.03). This model was used to predict the 3-yr OM risk. The interaction between predicted OM and LT status was significant (p<0.001). The benefit of LT on OM decreased progressively as predicted OM risk increased. Specifically, the 3-yr absolute improvement in OM-free survival was 15.7%, for patients with predicted OM risk ≤20% versus 0% for those with predicted OM risk ≥72%.
Men with mPCa at diagnosis benefit from LT in terms of OM. This is largely affected by baseline characteristics. Specifically, patients with a relatively low tumor risk and good general health status appear to benefit the most.
We used a large hospital-based database to evaluate which patients might benefit from local therapy when metastasized prostate cancer was present at diagnosis. Local therapy is associated with a survival benefit in men with less aggressive tumors and good general health.
Men with metastasized prostate cancer at diagnosis might benefit from local treatment in terms of overall mortality. Those with a relatively low tumor risk and good general health status seem to benefit the most.
Details
- Title: Subtitle
- The Impact of Local Treatment on Overall Survival in Patients with Metastatic Prostate Cancer on Diagnosis: A National Cancer Data Base Analysis
- Creators
- Björn Löppenberg - Ruhr University BochumDeepansh Dalela - Henry Ford Health SystemPatrick Karabon - Henry Ford Health SystemAkshay Sood - Henry Ford Health SystemJesse D. Sammon - Henry Ford Health SystemChristian P. Meyer - Brigham and Women's HospitalMaxine Sun - Brigham and Women's HospitalJoachim Noldus - Universitätsklinik Marien Hospital HerneJames O. Peabody - Henry Ford Health SystemQuoc-Dien Trinh - Brigham and Women's HospitalMani Menon - Henry Ford Health SystemFiras Abdollah - Henry Ford Health System
- Resource Type
- Journal article
- Publication Details
- European urology, Vol.72(1), pp.14-19
- DOI
- 10.1016/j.eururo.2016.04.031
- PMID
- 27174537
- NLM abbreviation
- Eur Urol
- ISSN
- 0302-2838
- eISSN
- 1873-7560
- Publisher
- Elsevier B.V
- Number of pages
- 6
- Language
- English
- Date published
- 07/01/2017
- Academic Unit
- Urology
- Record Identifier
- 9984949474202771
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