Benedikt Hoeh1,2, Christoph Würnschimmel2,3, Rocco S Flammia2,4, Benedikt Horlemann2, Gabriele Sorce2,5, Francesco Chierigo2,6, Zhe Tian2, Fred Saad2, Markus Graefen3, Michele Gallucci4, Alberto Briganti5, Carlo Terrone6, Shahrokh F Shariat7,8,9,10,11,12, Derya Tilki3,13, Luis A Kluth1, Philipp Mandel1, Felix K H Chun1, Pierre I Karakiewicz2. 1. Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany. 2. Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada. 3. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza Rome University, Rome, Italy. 5. Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 6. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy. 7. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. 8. Department of Urology, Weill Cornell Medical College, New York, New York, USA. 9. Department of Urology, University of Texas Southwestern, Dallas, Texas, USA. 10. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic. 11. Institute for Urology and Reproductive Health, I. M. Sechenov First Moscow State Medical University, Moscow, Russia. 12. Division of Urology, Department of Special Surger, Jordan University Hospital, The University of Jordan, Amman, Jordan. 13. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Abstract
INTRODUCTION: Over the last decade, multiple clinical trials demonstrated improved survival after chemotherapy for metastatic prostate cancer (mPCa). However, real-world data validating this effect within large-scale epidemiological data sets are scarce. We addressed this void. MATERIALS AND METHODS: Men with de novo mPCa were identified and systemic chemotherapy status was ascertained within the Surveillance, Epidemiology, and End Results database (2004-2016). Patients were divided between historical (2004-2013) versus contemporary (2014-2016). Chemotherapy rates were plotted over time. Kaplan-Meier plots and Cox regression models with additional multivariable adjustments addressed overall and cancer-specific mortality. All tests were repeated in propensity-matched analyses. RESULTS: Overall, 19,913 patients had de novo mPCa between 2004 and 2016. Of those, 1838 patients received chemotherapy. Of 1838 chemotherapy-exposed patients, 903 were historical, whereas 905 were contemporary. Chemotherapy rates increased from 5% to 25% over time. Median overall survival was not reached in contemporary patients versus was 24 months in historical patients (hazard ratio [HR]: 0.55, p < 0.001). After propensity score matching and additional multivariable adjustment (age, prostate-specific antigen, GGG, cT-stage, cN-stage, cM-stage, and local treatment) a HR of 0.55 (p < 0.001) was recorded. Analyses were repeated for cancer-specific mortality after adjustment for other cause mortality in competing risks regression models and recorded virtually the same findings before and after propensity score matching (HR: 0.55, p < 0.001). CONCLUSIONS: In mPCa patients, chemotherapy rates increased over time. A concomitant increase in survival was also recorded.
INTRODUCTION: Over the last decade, multiple clinical trials demonstrated improved survival after chemotherapy for metastatic prostate cancer (mPCa). However, real-world data validating this effect within large-scale epidemiological data sets are scarce. We addressed this void. MATERIALS AND METHODS: Men with de novo mPCa were identified and systemic chemotherapy status was ascertained within the Surveillance, Epidemiology, and End Results database (2004-2016). Patients were divided between historical (2004-2013) versus contemporary (2014-2016). Chemotherapy rates were plotted over time. Kaplan-Meier plots and Cox regression models with additional multivariable adjustments addressed overall and cancer-specific mortality. All tests were repeated in propensity-matched analyses. RESULTS: Overall, 19,913 patients had de novo mPCa between 2004 and 2016. Of those, 1838 patients received chemotherapy. Of 1838 chemotherapy-exposed patients, 903 were historical, whereas 905 were contemporary. Chemotherapy rates increased from 5% to 25% over time. Median overall survival was not reached in contemporary patients versus was 24 months in historical patients (hazard ratio [HR]: 0.55, p < 0.001). After propensity score matching and additional multivariable adjustment (age, prostate-specific antigen, GGG, cT-stage, cN-stage, cM-stage, and local treatment) a HR of 0.55 (p < 0.001) was recorded. Analyses were repeated for cancer-specific mortality after adjustment for other cause mortality in competing risks regression models and recorded virtually the same findings before and after propensity score matching (HR: 0.55, p < 0.001). CONCLUSIONS: In mPCa patients, chemotherapy rates increased over time. A concomitant increase in survival was also recorded.
Authors: Benedikt Hoeh; Christoph Würnschimmel; Rocco S Flammia; Benedikt Horlemann; Gabriele Sorce; Francesco Chierigo; Zhe Tian; Fred Saad; Markus Graefen; Michele Gallucci; Alberto Briganti; Carlo Terrone; Shahrokh F Shariat; Derya Tilki; Luis A Kluth; Philipp Mandel; Felix K H Chun; Pierre I Karakiewicz Journal: Front Oncol Date: 2021-11-23 Impact factor: 6.244