Early Mortality of Prostatectomy vs. Radiotherapy as a Primary Treatment for Prostate Cancer: A Population-Based Study From the United States and East Germany
Objective: To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database and East German epidemiologic cancer registries were used for the years 2005–2...
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| Veröffentlicht in: | Frontiers in oncology Jg. 9; S. 1451 |
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Frontiers Media S.A
17.01.2020
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| Abstract | Objective:
To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population.
Methods:
Data from the Surveillance, Epidemiology, and End Results (SEER) database and East German epidemiologic cancer registries were used for the years 2005–2013. Metastasized cases were excluded. Analyzing overall mortality, year-specific Cox regression models were used after adjusting for age (including age squared), risk stage, and grading. To estimate temporal hazards, we computed year-specific conditional hazards for surgery and radiotherapy after propensity-score matching and applied piecewise proportional hazard models.
Results:
In German and US populations, we observed higher initial 3-month mortality odds for prostatectomy (USA: 9.4, 95% CI: 7.8–11.2; Germany: 9.1, 95% CI: 5.1–16.2) approaching the null effect value not before 24-months (estimated annual mean 36-months in US data) after diagnosis. During the observational period, we observed a constant hazard ratio for the 24-month mortality in the US population (2005: 1.7, 95% CI: 1.5–1.9; 2013: 1.9, 95% CI: 1.6–2.2) comparing surgery and radiotherapy. The same was true in the German cohort (2005: 1.4, 95% CI: 0.9–2.1; 2013: 3.3, 95% CI: 2.2–5.1). Considering low-risk cases, the adverse surgery effect appeared stronger.
Conclusion:
There is strong evidence from two independent populations of a considerably higher early to midterm mortality after prostatectomy compared to radiotherapy extending the time of early mortality considered by previous studies up to 36-months. |
|---|---|
| AbstractList | To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population.
Data from the Surveillance, Epidemiology, and End Results (SEER) database and East German epidemiologic cancer registries were used for the years 2005-2013. Metastasized cases were excluded. Analyzing overall mortality, year-specific Cox regression models were used after adjusting for age (including age squared), risk stage, and grading. To estimate temporal hazards, we computed year-specific conditional hazards for surgery and radiotherapy after propensity-score matching and applied piecewise proportional hazard models.
In German and US populations, we observed higher initial 3-month mortality odds for prostatectomy (USA: 9.4, 95% CI: 7.8-11.2; Germany: 9.1, 95% CI: 5.1-16.2) approaching the null effect value not before 24-months (estimated annual mean 36-months in US data) after diagnosis. During the observational period, we observed a constant hazard ratio for the 24-month mortality in the US population (2005: 1.7, 95% CI: 1.5-1.9; 2013: 1.9, 95% CI: 1.6-2.2) comparing surgery and radiotherapy. The same was true in the German cohort (2005: 1.4, 95% CI: 0.9-2.1; 2013: 3.3, 95% CI: 2.2-5.1). Considering low-risk cases, the adverse surgery effect appeared stronger.
There is strong evidence from two independent populations of a considerably higher early to midterm mortality after prostatectomy compared to radiotherapy extending the time of early mortality considered by previous studies up to 36-months. Objective: To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database and East German epidemiologic cancer registries were used for the years 2005–2013. Metastasized cases were excluded. Analyzing overall mortality, year-specific Cox regression models were used after adjusting for age (including age squared), risk stage, and grading. To estimate temporal hazards, we computed year-specific conditional hazards for surgery and radiotherapy after propensity-score matching and applied piecewise proportional hazard models. Results: In German and US populations, we observed higher initial 3-month mortality odds for prostatectomy (USA: 9.4, 95% CI: 7.8–11.2; Germany: 9.1, 95% CI: 5.1–16.2) approaching the null effect value not before 24-months (estimated annual mean 36-months in US data) after diagnosis. During the observational period, we observed a constant hazard ratio for the 24-month mortality in the US population (2005: 1.7, 95% CI: 1.5–1.9; 2013: 1.9, 95% CI: 1.6–2.2) comparing surgery and radiotherapy. The same was true in the German cohort (2005: 1.4, 95% CI: 0.9–2.1; 2013: 3.3, 95% CI: 2.2–5.1). Considering low-risk cases, the adverse surgery effect appeared stronger. Conclusion: There is strong evidence from two independent populations of a considerably higher early to midterm mortality after prostatectomy compared to radiotherapy extending the time of early mortality considered by previous studies up to 36-months. Objective: To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database and East German epidemiologic cancer registries were used for the years 2005-2013. Metastasized cases were excluded. Analyzing overall mortality, year-specific Cox regression models were used after adjusting for age (including age squared), risk stage, and grading. To estimate temporal hazards, we computed year-specific conditional hazards for surgery and radiotherapy after propensity-score matching and applied piecewise proportional hazard models. Results: In German and US populations, we observed higher initial 3-month mortality odds for prostatectomy (USA: 9.4, 95% CI: 7.8-11.2; Germany: 9.1, 95% CI: 5.1-16.2) approaching the null effect value not before 24-months (estimated annual mean 36-months in US data) after diagnosis. During the observational period, we observed a constant hazard ratio for the 24-month mortality in the US population (2005: 1.7, 95% CI: 1.5-1.9; 2013: 1.9, 95% CI: 1.6-2.2) comparing surgery and radiotherapy. The same was true in the German cohort (2005: 1.4, 95% CI: 0.9-2.1; 2013: 3.3, 95% CI: 2.2-5.1). Considering low-risk cases, the adverse surgery effect appeared stronger. Conclusion: There is strong evidence from two independent populations of a considerably higher early to midterm mortality after prostatectomy compared to radiotherapy extending the time of early mortality considered by previous studies up to 36-months.Objective: To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database and East German epidemiologic cancer registries were used for the years 2005-2013. Metastasized cases were excluded. Analyzing overall mortality, year-specific Cox regression models were used after adjusting for age (including age squared), risk stage, and grading. To estimate temporal hazards, we computed year-specific conditional hazards for surgery and radiotherapy after propensity-score matching and applied piecewise proportional hazard models. Results: In German and US populations, we observed higher initial 3-month mortality odds for prostatectomy (USA: 9.4, 95% CI: 7.8-11.2; Germany: 9.1, 95% CI: 5.1-16.2) approaching the null effect value not before 24-months (estimated annual mean 36-months in US data) after diagnosis. During the observational period, we observed a constant hazard ratio for the 24-month mortality in the US population (2005: 1.7, 95% CI: 1.5-1.9; 2013: 1.9, 95% CI: 1.6-2.2) comparing surgery and radiotherapy. The same was true in the German cohort (2005: 1.4, 95% CI: 0.9-2.1; 2013: 3.3, 95% CI: 2.2-5.1). Considering low-risk cases, the adverse surgery effect appeared stronger. Conclusion: There is strong evidence from two independent populations of a considerably higher early to midterm mortality after prostatectomy compared to radiotherapy extending the time of early mortality considered by previous studies up to 36-months. Objective: To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database and East German epidemiologic cancer registries were used for the years 2005–2013. Metastasized cases were excluded. Analyzing overall mortality, year-specific Cox regression models were used after adjusting for age (including age squared), risk stage, and grading. To estimate temporal hazards, we computed year-specific conditional hazards for surgery and radiotherapy after propensity-score matching and applied piecewise proportional hazard models. Results: In German and US populations, we observed higher initial 3-month mortality odds for prostatectomy (USA: 9.4, 95% CI: 7.8–11.2; Germany: 9.1, 95% CI: 5.1–16.2) approaching the null effect value not before 24-months (estimated annual mean 36-months in US data) after diagnosis. During the observational period, we observed a constant hazard ratio for the 24-month mortality in the US population (2005: 1.7, 95% CI: 1.5–1.9; 2013: 1.9, 95% CI: 1.6–2.2) comparing surgery and radiotherapy. The same was true in the German cohort (2005: 1.4, 95% CI: 0.9–2.1; 2013: 3.3, 95% CI: 2.2–5.1). Considering low-risk cases, the adverse surgery effect appeared stronger. Conclusion: There is strong evidence from two independent populations of a considerably higher early to midterm mortality after prostatectomy compared to radiotherapy extending the time of early mortality considered by previous studies up to 36-months. |
| Author | Dietzel, Christian T. Medenwald, Daniel Vordermark, Dirk |
| AuthorAffiliation | Department of Radiation Oncology, University Hospital Halle (Saale) , Halle (Saale) , Germany |
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| Cites_doi | 10.5489/cuaj.749 10.1002/cncr.24008 10.1056/NEJMoa1615869 10.1016/j.radonc.2015.02.024 10.1056/NEJMoa1606220 10.1016/j.eururo.2013.09.046 10.1016/j.eururo.2019.04.002 10.1016/j.jclinepi.2016.04.014 10.1056/NEJMoa1807801 10.3332/ecancer.2014.413 10.1111/j.1464-410X.2005.05335.x 10.3322/caac.21387 10.1016/j.urology.2006.06.016 10.1002/cncr.32202 10.1007/s00120-016-0312-1 10.1016/S0090-4295(99)00100-4 10.1016/j.eururo.2016.08.003 10.1056/NEJMoa1311593 10.1056/NEJMoa1606221 |
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| Keywords | radiotherapy early mortality prostatectomy prostate cancer general population |
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| License | Copyright © 2020 Medenwald, Vordermark and Dietzel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Edited by: Scott T. Tagawa, Cornell University, United States This article was submitted to Genitourinary Oncology, a section of the journal Frontiers in Oncology Reviewed by: Shashwat Sharad, Center for Prostate Disease Research (CPDR), United States; Mohamed Saad Zaghloul, Cairo University, Egypt |
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| References_xml | – volume: 8 start-page: E75 year: 2014 ident: B17 article-title: Re-assessment of 30-, 60- and 90-day mortality rates in non-metastatic prostate cancer patients treated either with radical prostatectomy or radiation therapy publication-title: Can Urol Assoc J. doi: 10.5489/cuaj.749 – ident: B11 – volume: 115 start-page: 293 year: 2009 ident: B16 article-title: Major 30-day complications after radical radiotherapy: a population-based analysis and comparison with surgery publication-title: Cancer. doi: 10.1002/cncr.24008 – volume: 377 start-page: 132 year: 2017 ident: B4 article-title: Follow-up of prostatectomy versus observation for early prostate cancer publication-title: N Engl J Med. doi: 10.1056/NEJMoa1615869 – volume: 115 start-page: 90 year: 2015 ident: B2 article-title: Integrated prostate cancer centers might cause an overutilization of radiotherapy for low-risk prostate cancer: a comparison of treatment trends in the United States and Germany from 2004 to 2011 publication-title: Radiother Oncol. doi: 10.1016/j.radonc.2015.02.024 – volume: 375 start-page: 1415 year: 2016 ident: B6 article-title: 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer publication-title: N Engl J Med. doi: 10.1056/NEJMoa1606220 – volume: 65 start-page: 124 year: 2014 ident: B10 article-title: EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013 publication-title: Eur Urol. doi: 10.1016/j.eururo.2013.09.046 – volume: 76 start-page: 137 year: 2019 ident: B20 article-title: Restricted mean survival times to improve communication of evidence from cancer randomized trials and observational studies publication-title: Eur Urol. doi: 10.1016/j.eururo.2019.04.002 – volume: 79 start-page: 70 year: 2016 ident: B9 article-title: Specifying a target trial prevents immortal time bias and other self-inflicted injuries in observational analyses publication-title: J Clin Epidemiol. doi: 10.1016/j.jclinepi.2016.04.014 – volume: 379 start-page: 2319 year: 2018 ident: B19 article-title: Radical prostatectomy or watchful waiting in prostate cancer - 29-year follow-up publication-title: N Engl J Med. doi: 10.1056/NEJMoa1807801 – volume: 8 start-page: 413 year: 2014 ident: B8 article-title: Cancer registries can provide evidence-based data to improve quality of care and prevent cancer deaths publication-title: Ecancermedicalscience. doi: 10.3332/ecancer.2014.413 – volume: 95 start-page: 541 year: 2005 ident: B15 article-title: Examining the location and cause of death within 30-days of radical prostatectomy publication-title: BJU Int. doi: 10.1111/j.1464-410X.2005.05335.x – volume: 67 start-page: 7 year: 2017 ident: B1 article-title: Cancer Statistics, 2017 publication-title: CA Cancer J Clin. doi: 10.3322/caac.21387 – volume: 68 start-page: 1057 year: 2006 ident: B13 article-title: Rethinking 30-day mortality risk after radical prostatectomy publication-title: Urology. doi: 10.1016/j.urology.2006.06.016 – volume: 125 start-page: 3164 year: 2019 ident: B21 article-title: Use and early mortality outcomes of active surveillance in patients with intermediate-risk prostate cancer publication-title: Cancer. doi: 10.1002/cncr.32202 – volume: 56 start-page: 231 year: 2017 ident: B5 article-title: PREFERE - the failure of an (almost) perfect study: does the human factor interfere when answering highly complex questions? publication-title: Der Urologe. doi: 10.1007/s00120-016-0312-1 – volume: 54 start-page: 301 year: 1999 ident: B14 article-title: Effect of age and surgical approach on complications and short-term mortality after radical prostatectomy–a population-based study publication-title: Urology. doi: 10.1016/S0090-4295(99)00100-4 – volume: 71 start-page: 618 year: 2017 ident: B18 article-title: EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent publication-title: Eur Urol. doi: 10.1016/j.eururo.2016.08.003 – volume: 370 start-page: 932 year: 2014 ident: B3 article-title: Radical prostatectomy or watchful waiting in early prostate cancer publication-title: N Engl J Med. doi: 10.1056/NEJMoa1311593 – volume: 375 start-page: 1425 year: 2016 ident: B7 article-title: Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer publication-title: N Engl J Med. doi: 10.1056/NEJMoa1606221 – start-page: 165 volume-title: Proceedings of the 29th Annual SAS Users Group International Conference year: 2004 ident: B12 article-title: Performing a 1:N Case–Control Match on Propensity Score |
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To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population.
Methods:
Data from... To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population. Data from the Surveillance,... Objective: To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population. Methods: Data from... Objective: To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population.Methods: Data from... |
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| Title | Early Mortality of Prostatectomy vs. Radiotherapy as a Primary Treatment for Prostate Cancer: A Population-Based Study From the United States and East Germany |
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