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Interaction of adjuvant androgen deprivation therapy with patient comorbidity status on overall survival after radical prostatectomy for high-risk prostate cancer.
- Source :
-
International journal of urology : official journal of the Japanese Urological Association [Int J Urol] 2013 Aug; Vol. 20 (8), pp. 798-805. Date of Electronic Publication: 2012 Dec 20. - Publication Year :
- 2013
-
Abstract
- Background: To evaluate the impact of adjuvant hormonal therapy after radical prostatectomy on overall survival in high-risk prostate cancer patients, stratified by comorbidity status.<br />Methods: We identified 1247 patients who underwent radical prostatectomy from 1988 to 2004 for high-risk prostate cancer, as defined by National Comprehensive Cancer Network classification. Comorbidity status was stratified by Charlson Comorbidity Index as 0, 1 or >2, as well as by the presence or absence of cardiovascular disease. Overall survival was estimated by the Kaplan-Meier method, and compared within each comorbidity category/adjuvant hormonal therapy strata with the log-rank test.<br />Results: Median patient age was 65 years, and the median postoperative follow up was 11.2 years. In total, 419 patients (34%) received adjuvant hormonal therapy. The distribution of Charlson Comorbidity Index was 0, 1 and ≥ 2 in 861 (69%), 244 (20%) and 142 (11%) patients, respectively. The 10-year overall survival for patients who received adjuvant hormonal therapy versus those who did not was 75% versus 82% (P=0.54) for patients with Charlson Comorbidity Index=0, 72% versus 76% (P=0.83) with Charlson Comorbidity Index=1, and 70% versus 68% (P=0.33) with Charlson Comorbidity Index ≥ 2. Meanwhile, 155 (12%) patients had cardiovascular disease, and the 10-year overall survival for patients with cardiovascular disease who received adjuvant hormonal therapy was 72%, compared with 76% without adjuvant hormonal therapy (P=0.97). On multivariate analysis, receipt of adjuvant hormonal therapy was not associated with non-prostate cancer mortality (P=0.24).<br />Conclusions: Adjuvant hormonal therapy after radical prostatectomy for high-risk prostate cancer does not increase non-prostate cancer mortality, even among patients with multiple comorbidities. Additional studies are warranted to determine optimal multimodal treatment approach for high-risk patients.<br /> (© 2012 The Japanese Urological Association.)
- Subjects :
- Aged
Chemotherapy, Adjuvant methods
Combined Modality Therapy
Comorbidity
Disease-Free Survival
Follow-Up Studies
Humans
Male
Middle Aged
Registries statistics & numerical data
Risk Factors
Androgen Antagonists therapeutic use
Prostatectomy methods
Prostatic Neoplasms drug therapy
Prostatic Neoplasms mortality
Prostatic Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1442-2042
- Volume :
- 20
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- International journal of urology : official journal of the Japanese Urological Association
- Publication Type :
- Academic Journal
- Accession number :
- 23278850
- Full Text :
- https://doi.org/10.1111/iju.12047