Sophie Knipper1,2, Cristina Dzyuba-Negrean3, Carlotta Palumbo3,4, Angela Pecoraro3,5, Giuseppe Rosiello3,6, Zhe Tian3, Alberto Briganti6, Fred Saad3, Derya Tilki7,8, Markus Graefen7, Pierre I Karakiewicz3. 1. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. a.knipper@uke.de. 2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada. a.knipper@uke.de. 3. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada. 4. Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy. 5. Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy. 6. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 7. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. 8. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Abstract
PURPOSE: There is no contemporary proof of cancer-control benefits in octogenarian clinically localized prostate cancer (PCa) patients with life expectancy (LE) < 10 years. Therefore, cancer-specific mortality (CSM) rates after external beam radiation therapy (EBRT) vs. no local treatment (NLT) were tested in octogenarian PCa patients with LE < 10 years. METHODS: Within the surveillance, epidemiology, and end results database (2004-2015), we identified 22,361 octogenarian clinically localized PCa patients who either received EBRT or NLT. Temporal trends, cumulative incidence plots and multivariable competing-risks regression analyses (MCR) were used after propensity score matching. Sensitivity analyses were performed according to D'Amico risk groups and LE > 5 years. RESULTS: Of all, 7325 (32.8%) received EBRT vs. 15,036 (67.2%) received NLT. Rates of EBRT significantly increased over time (25.0-42.4%). Overall, 10-year CSM rates were 10.6% vs. 17.0% and 10-year other-cause mortality rates were 50.3% vs. 58.1%, in EBRT vs. NLT patients (both p < 0.001). In MCR focusing on the overall cohort, EBRT represented an independent predictor of lower CSM (hazard ratio: 0.5). In sensitivity analyses, hazard ratios of 0.5 (p < 0.001), 0.5 (p < 0.001) and 0.8 (p = 0.5) were, respectively, recorded in D'Amico high-, intermediate- and low-risk patients. In sensitivity analyses addressing patients with LE > 5 years virtually the same results were recorded. CONCLUSIONS: In octogenarian patients with LE < 10 years, EBRT seems to be associated with lower CSM in D'Amico high-risk, as well as in D'Amico intermediate-risk patients relative to their NLT counterparts. Based on these observations, greater consideration for EBRT may be given in octogenarian patients.
PURPOSE: There is no contemporary proof of cancer-control benefits in octogenarian clinically localized prostate cancer (PCa) patients with life expectancy (LE) < 10 years. Therefore, cancer-specific mortality (CSM) rates after external beam radiation therapy (EBRT) vs. no local treatment (NLT) were tested in octogenarian PCapatients with LE < 10 years. METHODS: Within the surveillance, epidemiology, and end results database (2004-2015), we identified 22,361 octogenarian clinically localized PCapatients who either received EBRT or NLT. Temporal trends, cumulative incidence plots and multivariable competing-risks regression analyses (MCR) were used after propensity score matching. Sensitivity analyses were performed according to D'Amico risk groups and LE > 5 years. RESULTS: Of all, 7325 (32.8%) received EBRT vs. 15,036 (67.2%) received NLT. Rates of EBRT significantly increased over time (25.0-42.4%). Overall, 10-year CSM rates were 10.6% vs. 17.0% and 10-year other-cause mortality rates were 50.3% vs. 58.1%, in EBRT vs. NLT patients (both p < 0.001). In MCR focusing on the overall cohort, EBRT represented an independent predictor of lower CSM (hazard ratio: 0.5). In sensitivity analyses, hazard ratios of 0.5 (p < 0.001), 0.5 (p < 0.001) and 0.8 (p = 0.5) were, respectively, recorded in D'Amico high-, intermediate- and low-risk patients. In sensitivity analyses addressing patients with LE > 5 years virtually the same results were recorded. CONCLUSIONS: In octogenarian patients with LE < 10 years, EBRT seems to be associated with lower CSM in D'Amico high-risk, as well as in D'Amico intermediate-risk patients relative to their NLT counterparts. Based on these observations, greater consideration for EBRT may be given in octogenarian patients.
Entities:
Keywords:
Cancer-specific mortality; D’Amico risk groups; Life expectancy; Local treatment; SEER
Authors: Paolo Dell'Oglio; Katharina Boehm; Vincent Trudeau; Zhe Tian; Alessandro Larcher; Sami-Ramzi Leyh-Bannurah; Marco Moschini; Umberto Capitanio; Shahrokh F Shariat; Alberto Briganti; Francesco Montorsi; Fred Saad; Pierre I Karakiewicz Journal: Int J Radiat Oncol Biol Phys Date: 2016-05-10 Impact factor: 7.038
Authors: A V D'Amico; R Whittington; S B Malkowicz; D Schultz; K Blank; G A Broderick; J E Tomaszewski; A A Renshaw; I Kaplan; C J Beard; A Wein Journal: JAMA Date: 1998-09-16 Impact factor: 56.272
Authors: Anne-Michelle Noone; Kathleen A Cronin; Sean F Altekruse; Nadia Howlader; Denise R Lewis; Valentina I Petkov; Lynne Penberthy Journal: Cancer Epidemiol Biomarkers Prev Date: 2016-12-12 Impact factor: 4.254
Authors: Martin G Sanda; Jeffrey A Cadeddu; Erin Kirkby; Ronald C Chen; Tony Crispino; Joann Fontanarosa; Stephen J Freedland; Kirsten Greene; Laurence H Klotz; Danil V Makarov; Joel B Nelson; George Rodrigues; Howard M Sandler; Mary Ellen Taplin; Jonathan R Treadwell Journal: J Urol Date: 2017-12-15 Impact factor: 7.450