Competing mortality contributes to excess mortality in patients with poor-risk lymph node-positive prostate cancer treated with radical prostatectomy

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Michael Froehner - , University Hospital Carl Gustav Carus Dresden, Department of Urology (Author)
  • Albrecht Scholz - , HELIOS Clinic Aue (Author)
  • Rainer Koch - , University Hospital Carl Gustav Carus Dresden, Institute for Medical Informatics and Biometry (Author)
  • Oliver W. Hakenberg - , University of Rostock (Author)
  • Gustavo B. Baretton - , Institute of Pathology, University Hospital Carl Gustav Carus Dresden (Author)
  • Manfred P. Wirth - , University Hospital Carl Gustav Carus Dresden, Department of Urology (Author)

Abstract

Background: Factors predicting survival in men with lymph node-positive prostate cancer are still poorly defined. Patients and Methods: 193 prostate cancer patients with histopathologically proven lymph node involvement with a median follow-up of 7.3 years were studied. 94% of patients received immediate hormonal therapy. Kaplan-Meier curves were calculated to evaluate overall survival rates and compared with the log-rank test. Cumulative disease-specific and competing mortality rates were calculated by competing risk analysis and compared with the Pepe-Mori test. Cox proportional hazard models were used to determine the independent significance of predictors of all-cause mortality. Results: Age (70 years or older vs. younger), Gleason score (8-10 vs. 7 or lower) and the number of involved nodes (3 or more vs. 1-2) were identified as independent predictors of all-cause mortality. When patients with 0-1 of these risk factors were compared with those with 2-3 risk factors, all-cause (rates after 10 years 21% vs. 71%, p < 0.0001), disease-specific (12 vs. 37%, p = 0.009) and competing mortality (9 vs. 33%, p = 0.02) differed significantly. Conclusions: Some of the excess mortality in patients with poor-risk lymph node-positive prostate cancer may be attributed to increased competing mortality, possibly caused by an interaction between comorbid diseases and hormonally treated persistent or progressive prostate cancer.

Details

Original languageEnglish
Pages (from-to)148-154
Number of pages7
JournalUrologia internationalis
Volume89
Issue number2
Publication statusPublished - Sept 2012
Peer-reviewedYes

External IDs

PubMed 22813937

Keywords

Sustainable Development Goals

ASJC Scopus subject areas

Keywords

  • Competing mortality, Disease-specific survival, Lymph nodes, Overall survival, Prognostic factors, Prostate cancer, Radical prostatectomy, Urological neoplasms