Level of education and mortality after radical prostatectomy

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Michael Froehner - , University Hospital Carl Gustav Carus Dresden, Department of Urology (Author)
  • Rainer Koch - , University Hospital Carl Gustav Carus Dresden, Institute for Medical Informatics and Biometry (Author)
  • Stefan Propping - , University Hospital Carl Gustav Carus Dresden, Department of Urology (Author)
  • Dorothea Liebeheim - , University Hospital Carl Gustav Carus Dresden, Department of Urology (Author)
  • Matthias Hübler - , University Hospital Carl Gustav Carus Dresden, Department of Anesthesiology and Intensive Care Medicine (Author)
  • Gustavo B. Baretton - , Institute of Pathology, University Hospital Carl Gustav Carus Dresden (Author)
  • Oliver W. Hakenberg - , University of Rostock (Author)
  • Manfred P. Wirth - , University Hospital Carl Gustav Carus Dresden, Department of Urology (Author)

Abstract

Estimating the risk of competing mortality is of importance in men with early prostate cancer to choose the most appropriate way of management and to avoid over-or under-treatment. In this study, we investigated the impact of the level of education in this context. The study sample consisted of 2630 patients with complete data on level of education (college, university degree, master craftsmen, comparable profession, or others), histopathological tumor stage (organ confined or extracapsular), lymph node status (negative or positive), and prostatectomy specimen Gleason score (<7, 7, or 8-10) who underwent radical prostatectomy between 1992 and 2007. Overall, prostate cancer-specific, competing, and second cancer-related mortalities were study endpoints. Cox proportional hazard models for competing risks were used to study combined effects of the variables on these endpoints. A higher level of education was independently associated with decreased overall mortality after radical prostatectomy (hazard ratio [HR]: 0.75, 95% confidence interval [95% CI]: 0.62-0.91, P = 0.0037). The mortality difference was attributable to decreased second cancer mortality (HR: 0.59, 95% CI: 0.40-0.85, P = 0.0052) and noncancer mortality (HR: 0.73, 95% CI: 0.55-0.98, P = 0.0345) but not to differences in prostate cancer-specific mortality (HR: 1.16, 95% CI: 0.79-1.69, P = 0.4536 in the full model). In conclusion, the level of education might serve as an independent prognostic parameter supplementary to age, comorbidity, and smoking status to estimate the risk of competing mortality and to choose optimal treatment for men with early prostate cancer who are candidates for radical prostatectomy.

Details

Original languageEnglish
Pages (from-to)173-177
Number of pages5
JournalAsian Journal of Andrology
Volume19
Issue number2
Publication statusPublished - 2017
Peer-reviewedYes

External IDs

PubMed 28051039

Keywords

Sustainable Development Goals

ASJC Scopus subject areas

Keywords

  • Comorbidity, Competing risk analysis, Level of education, Life expectancy, Mortality, Proportional hazards model, Prostate cancer, Radical prostatectomy, Smoking, Socioeconomic status