Abstract
IntroductionRandomized clinical trials demonstrated improved overall survival in chemotherapy exposed metastatic prostate cancer patients. However, real-world data validating this effect with large scale epidemiological data sets are scarce and might not agree with trials. We tested this hypothesis.Materials and MethodsWe identified de novo metastatic prostate cancer patients within the Surveillance, Epidemiology, and End Results (SEER) database (2014-2015). Kaplan-Meier plots and Cox regression models tested for overall survival differences between chemotherapy-exposed patients vs chemotherapy-naïve patients. All analyses were repeated in propensity-score matched cohorts. Additionally, landmark analyses were applied to account for potential immortal time bias.ResultsOverall, 4295 de novo metastatic prostate cancer patients were identified. Of those, 905 (21.1%) patients received chemotherapy vs 3390 (78.9%) did not. Median overall survival was not reached at 30 months follow-up. Chemotherapy-exposed patients exhibited significantly better overall survival (61.6 vs 54.3%, multivariable HR:0.82, CI: 0.72-0.96, p=0.01) at 30 months compared to their chemotherapy-naïve counterparts. These findings were confirmed in propensity score matched analyses (multivariable HR: 0.77, CI:0.66-0.90, p<0.001). Results remained unchanged after landmark analyses were applied in propensity score matched population.ConclusionsIn this contemporary real-world population-based cohort, chemotherapy for metastatic prostate cancer patients was associated with better overall survival. However, the magnitude of overall survival benefit was not comparable to phase 3 trials.
Highlights
Randomized clinical trials demonstrated improved overall survival in chemotherapy exposed metastatic prostate cancer patients
Only one report demonstrated a modest benefit in overall survival after chemotherapy in contemporary, de novo metastatic prostate cancer patients (Weiner et al, National Cancer Database 2014-2015) [9]
We hypothesized that chemotherapy use may result in a survival benefit for de novo metastatic prostate cancer patients [9]
Summary
Randomized clinical trials demonstrated improved overall survival in chemotherapy exposed metastatic prostate cancer patients. Real-world data validating this effect with large scale epidemiological data sets are scarce and might not agree with trials. Only one report demonstrated a modest benefit in overall survival after chemotherapy in contemporary, de novo metastatic prostate cancer patients (Weiner et al, National Cancer Database 2014-2015) [9]. Large-scale database (SEER), we focused on the most contemporary patients (2014-2015) diagnosed with de novo metastatic prostate cancer. We hypothesized that chemotherapy use may result in a survival benefit for de novo metastatic prostate cancer patients [9]. Unlike Weiner et al, we relied on propensity score matching to maximally reduce potential differences between chemotherapyexposed and chemotherapy-naïve patients
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