Giorgio Gandaglia1, Maxine Sun2, Ioana Popa2, Jonas Schiffmann2, Vincent Trudeau2, Shahrokh F Shariat3, Quoc-Dien Trinh4, Markus Graefen5, Hugues Widmer6, Fred Saad6, Alberto Briganti7, Francesco Montorsi7, Pierre I Karakiewicz8. 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Department of Urology, Vita Salute San Raffaele University, Milan, Italy. Electronic address: giorgan10@libero.it. 2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada. 3. Department of Urology, Medical University of Vienna, Vienna, Austria. 4. Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA. 5. Martini-Klinik, Prostate Cancer Center, University-Hospital Hamburg-Eppendorf, Hamburg, Germany. 6. Department of Surgery, Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada. 7. Department of Urology, Vita Salute San Raffaele University, Milan, Italy. 8. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Department of Surgery, Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
Abstract
INTRODUCTION: The aim of our study was to reexamine the prevalence of baseline cardiovascular (CV) morbidity and the rates of CV mortality in a contemporary cohort of patients with prostate cancer (PCa) exposed to androgen deprivation therapy (ADT). MATERIALS AND METHODS: Records of patients aged 65 years and older with metastatic PCa who received ADT were abstracted from the Surveillance, Epidemiology, and End Results-Medicare database between 1991 and 2009. The primary end points comprised 5-year CV mortality rates. Survival rates were stratified according to age and Charlson comorbidity index (CCI). Competing-risks Poisson regression methodologies were performed. RESULTS: Overall, 9596 patients with metastatic PCa treated with ADT were identified. At baseline, 3049 patients (31.8%) had preexisting CV disease. The 5-year CV mortality rates were 9.8% and 14.8% in the overall population and in patients with preexisting CV disease, respectively. The 5-year CV mortality rates increased with advanced age and higher CCI score. In multivariate competing-risks regression analyses, age, year of diagnosis, CV comorbidities, CCI, and marital status represented independent predictors of CV mortality, after accounting for the risk of dying from other causes (all P ≤ .04). Of those, preexisting CV disease contributed to the highest risk of CV mortality. Our study is limited by its retrospective nature. CONCLUSION: CV mortality represents a common event in patients with metastatic PCa treated with ADT. Preexisting CV disease represented the strongest risk factor.
INTRODUCTION: The aim of our study was to reexamine the prevalence of baseline cardiovascular (CV) morbidity and the rates of CV mortality in a contemporary cohort of patients with prostate cancer (PCa) exposed to androgen deprivation therapy (ADT). MATERIALS AND METHODS: Records of patients aged 65 years and older with metastatic PCa who received ADT were abstracted from the Surveillance, Epidemiology, and End Results-Medicare database between 1991 and 2009. The primary end points comprised 5-year CV mortality rates. Survival rates were stratified according to age and Charlson comorbidity index (CCI). Competing-risks Poisson regression methodologies were performed. RESULTS: Overall, 9596 patients with metastatic PCa treated with ADT were identified. At baseline, 3049 patients (31.8%) had preexisting CV disease. The 5-year CV mortality rates were 9.8% and 14.8% in the overall population and in patients with preexisting CV disease, respectively. The 5-year CV mortality rates increased with advanced age and higher CCI score. In multivariate competing-risks regression analyses, age, year of diagnosis, CV comorbidities, CCI, and marital status represented independent predictors of CV mortality, after accounting for the risk of dying from other causes (all P ≤ .04). Of those, preexisting CV disease contributed to the highest risk of CV mortality. Our study is limited by its retrospective nature. CONCLUSION: CV mortality represents a common event in patients with metastatic PCa treated with ADT. Preexisting CV disease represented the strongest risk factor.
Authors: Sarathi Kalra; Spyridon Basourakos; Angela Abouassi; Mary Achim; Robert J Volk; Karen E Hoffman; John W Davis; Jeri Kim Journal: Nat Rev Urol Date: 2016-03-22 Impact factor: 14.432