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Competing-Risks Mortality After Radiotherapy vs. Observation for Localized Prostate Cancer: A Population-based Study
- Source :
- International Journal of Radiation Oncology*Biology*Physics. 84:95-103
- Publication Year :
- 2012
- Publisher :
- Elsevier BV, 2012.
-
Abstract
- Purpose Contemporary patients with localized prostate cancer (PCa) are more frequently treated with radiotherapy. However, there are limited data on the effect of this treatment on cancer-specific mortality (CSM). Our objective was to test the relationship between radiotherapy and survival in men with localized PCa and compare it with those treated with observation. Methods A population-based cohort identified 68,797 men with cT1–T2 PCa treated with radiotherapy or observation between the years 1992 and 2005. Propensity-score matching was used to minimize potential bias related to treatment assignment. Competing-risks analyses tested the effect of treatment type (radiotherapy vs. observation) on CSM, after accounting to other-cause mortality. All analyses were carried out within PCa risk, baseline comorbidity status, and age groups. Results Radiotherapy was associated with more favorable 10-year CSM rates than observation in patients with high-risk PCa (8.8 vs. 14.4%, hazard ratio [HR]: 0.59, 95% confidence interval [CI]: 0.50–0.68). Conversely, the beneficial effect of radiotherapy on CSM was not evident in patients with low-intermediate risk PCa (3.7 vs. 4.1%, HR: 0.91, 95% CI: 0.80–1.04). Radiotherapy was beneficial in elderly patients (5.6 vs. 7.3%, HR: 0.70, 95% CI: 0.59–0.80). Moreover, it was associated with improved CSM rates among patients with no comorbidities (5.7 vs. 6.5%, HR: 0.81, 95% CI: 0.67–0.98), one comorbidity (4.6 vs. 6.0%, HR: 0.87, 95% CI: 0.75–0.99), and more than two comorbidities (4.2 vs. 5.0%, HR: 0.79, 95% CI: 0.65–0.96). Conclusions Radiotherapy substantially improves CSM in patients with high-risk PCa, with little or no benefit in patients with low-/intermediate-risk PCa relative to observation. These findings must be interpreted within the context of the limitations of observational data.
- Subjects :
- Male
Cancer Research
medicine.medical_specialty
medicine.medical_treatment
Population
Context (language use)
Comorbidity
Medicare
Risk Assessment
Cause of Death
Internal medicine
medicine
Humans
Radiology, Nuclear Medicine and imaging
Watchful Waiting
education
Aged
Neoplasm Staging
Aged, 80 and over
education.field_of_study
Radiation
Radiotherapy
business.industry
Hazard ratio
Age Factors
Prostatic Neoplasms
Prostate-Specific Antigen
medicine.disease
United States
Confidence interval
Surgery
Prostate-specific antigen
Socioeconomic Factors
Oncology
Cohort
Neoplasm Grading
business
Watchful waiting
SEER Program
Subjects
Details
- ISSN :
- 03603016
- Volume :
- 84
- Database :
- OpenAIRE
- Journal :
- International Journal of Radiation Oncology*Biology*Physics
- Accession number :
- edsair.doi.dedup.....d3f185bbf39915aa739ed252a0463838