Elio Mazzone1, Felix Preisser2, Sebastiano Nazzani3, Zhe Tian4, Marco Bandini5, Giorgio Gandaglia6, Nicola Fossati6, Denis Soulières4, Markus Graefen7, Francesco Montorsi6, Shahrokh F Shariat8, Fred Saad4, Alberto Briganti6, Pierre I Karakiewicz4. 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: eliomazzone@gmail.com. 2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy. 4. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. 5. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. 6. Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. 7. Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 8. Department of Urology, Medical University of Vienna, Vienna, Austria.
Abstract
PURPOSE: To quantify the prognostic effect of the location of prostate cancer (PCa) metastases on cancer-specific mortality (CSM) and the rate of other-cause mortality (OCM) in contemporary newly diagnosed metastatic PCa (mPCa) patients. PATIENTS AND METHODS: Within the Surveillance Epidemiology and End Results database (2004-2014), we focused on newly diagnosed mPCa patients. Data were stratified according to the site of metastases and age group. Cumulative incidence smoothed plots were generated for CSM and OCM at 5 years after diagnosis, according to the competing-risks methods. Multivariable competing-risks analyses tested the effect of the location of PCa metastases on CSM. RESULTS: Among 18,404 patients with mPCa, the majority had exclusively bone metastases (63.6%). At 5 years, CSM rate was 59.7% and OCM rate was 14%. According to the location of metastases, CSM rates were 44.5%, 57.9%, 67.1%, 62.7%, 66%, and 76.3% for exclusively lymph node (LN), exclusively bone, bone plus LN, exclusively visceral, visceral plus LN, and visceral plus LN and bone disease, respectively. In multivariable competing-risks models, PCa-specific mortality rate was 1.58-, 1.79-, 1.91-, 2.10-, and 2.47-fold higher in patients with exclusively bone, bone plus LN, exclusively visceral, visceral plus LN, and visceral plus bone and LN involvement compared to those with exclusively LN metastases (all P < .001). CONCLUSION: Patients with concomitant visceral, bone, and LN metastases have the worst prognosis. Similarly, when either bone or visceral metastases coexist with concomitant LN metastases, CSM rates are higher than when no concomitant LN metastases are present.
PURPOSE: To quantify the prognostic effect of the location of prostate cancer (PCa) metastases on cancer-specific mortality (CSM) and the rate of other-cause mortality (OCM) in contemporary newly diagnosed metastatic PCa (mPCa) patients. PATIENTS AND METHODS: Within the Surveillance Epidemiology and End Results database (2004-2014), we focused on newly diagnosed mPCa patients. Data were stratified according to the site of metastases and age group. Cumulative incidence smoothed plots were generated for CSM and OCM at 5 years after diagnosis, according to the competing-risks methods. Multivariable competing-risks analyses tested the effect of the location of PCa metastases on CSM. RESULTS: Among 18,404 patients with mPCa, the majority had exclusively bone metastases (63.6%). At 5 years, CSM rate was 59.7% and OCM rate was 14%. According to the location of metastases, CSM rates were 44.5%, 57.9%, 67.1%, 62.7%, 66%, and 76.3% for exclusively lymph node (LN), exclusively bone, bone plus LN, exclusively visceral, visceral plus LN, and visceral plus LN and bone disease, respectively. In multivariable competing-risks models, PCa-specific mortality rate was 1.58-, 1.79-, 1.91-, 2.10-, and 2.47-fold higher in patients with exclusively bone, bone plus LN, exclusively visceral, visceral plus LN, and visceral plus bone and LN involvement compared to those with exclusively LN metastases (all P < .001). CONCLUSION:Patients with concomitant visceral, bone, and LN metastases have the worst prognosis. Similarly, when either bone or visceral metastases coexist with concomitant LN metastases, CSM rates are higher than when no concomitant LN metastases are present.
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