Risk Of Other-cause Mortality Research Articles

Is radiotherapy after radical prostatectomy associated with higher other-cause mortality?

The aim of this study was to reveal the association between the other-cause mortality (OCM) and post-radical prostatectomy (RP) salvage radiotherapy (sRT) in men with prostate cancer (PCa). A retrospective study was carried out with patients who had PCa and underwent RP ± sRT in a high-volume cancer center between 2005 and February 2019. Data from 1955 patients were subjected to a 1:1 matching for age, initial PSA, pathological (p)T/N stages, and ISUP score, which yielding 439 RP + RT (group 1) vs 439 RP-only cases (group 2), without any residual difference. Primary and secondary endpoints of the study were OCM and cancer-specific mortality (CSM). Kaplan-Meier, log-rank, and cox regression tests were used for purpose of the study. The median follow-up time after RP was 5.3years (interquartile range: 4.0-7.3). After matching, of all deaths that occurred during the study period, 16 in group 1 and 35 in group 2 were attributed to other causes (p = 0.006). 5-year OCM rate of patients who received sRT (1.2%) was significantly lower compared to patients that underwent RP-only (4.4%, p < 0.001). 19 versus 16 patients died of PCa, respectively (p = 0.61). There was no CSM risk difference between groups (p = 0.29). Older patients had an increased risk of OCM (hazard ratio [HR]:1.10 [95%CI 1.05-1.17], p < 0.001) and post-RP RT was associated with lower OCM (HR: 0.28 [95%CI 0.15-0.51], p < 0.001) in multivariable model. pT/N stages and ISUP score were strongly associated with CSM, but not with OCM. OCM was not higher in patients who had sRT with or without ADT. Excess OCM in favor of RP-only patients may be cautiously explained with higher-performance status/life expectancy of patients who selected for RT after RP in our cohort.

Radiation after radical prostatectomy in elderly patients - a SEER database-derived competing-risk survival analysis of propensity score-matched age groups.

This study aimed to evaluate cancer-specific (CSM) and other-cause mortality (OCM) in elderly patients with prostate cancer treated with radical prostatectomy (RP) and postoperative radiotherapy (RT). The Surveillance, Epidemiology, and End Results (SEER) database was searched for clinically non-metastatic prostate cancer (PCa) treated with RT after RP between 2010 and 2015. Patients were stratified according to age groups and underwent propensity score (PS) matching. The Kaplan-Meier method and competing-risk Cox regression (CRR) were used for survival analysis. In total, 5385 patients were analysed, including 738 (13.7%) elderly patients (≥70 years old) and 4647 (86.29%) younger individuals. A total of 54 (7.32%) and 69 (9.35%) patients aged ≥70 years died due to PCa and competing reasons, respectively. Among younger patients these included 275 (5.92%) and 208 (4.48%) deaths, respectively. At a median follow-up of 80 months, patients ≥70 years old had significantly shorter OCM (p <0.0001) than PS-matched younger controls without significant impairment of cancer-specific survival when compared to controls (p = 0.19). In CRR analysis older patients were at significantly higher risk of OCM (HR = 2.24, p = 0.0002 and HR = 3.3, p = 0.011 for patients aged ≥70 and ≥75 years, respectively). Simultaneously, the CRR revealed no increased risk of CSM for patients older than 70 and 75 years (HR = 1.2, p = 0.33 and HR = 1.53, p = 0.29, respectively). Elderly patients with PCa are at high risk of dying due to competing reasons, which might prevent the survival benefit of RT after RP. Selection for salvage and adjuvant RT in these individuals should be cautious.

Multidisciplinary team referral at diagnosis for patients with non-metastatic renal cell carcinoma.

To date, multidisciplinary team (MDT) evaluation, enrollment in trials evaluating the role of perioperative therapies and deferred active treatments represent accepted strategies for patients with Renal Cell Carcinoma (RCC), which are under investigation to maximize cancer control and implement health care policies and value-based care. Here, we aimed to identify subgroups of patients with RCC who may benefit from early referral for MDT evaluation at diagnosis in light of an increased risk of recurrence relative to the risk of dying of other causes. We relied on a prospective dataset including patients diagnosed with RCC from 1998 to 2019 and treated by means of surgery alone at a tertiary referral center. The risk of other cause mortality (OCM) was evaluated against the risk of distant metastasis over time by means of the Weibull regression. Patients were stratified based on clinical stage (cT1a; cT1b; cT2; cT3-4), age (<60; 60-70; >70) and comorbidities [Charlson comorbidity index (CCI) 0 vs. ≥1]. For each combination of cT stage, age, and CCI, the potential need for an MDT referral was defined when the risk of recurrence exceeded the risk of OCM within the lower limit of the 95% CI of the meantime to recurrence. Overall, 1,162 (51%) patients had no comorbidities. Median follow-up was 7 years. Patients who would benefit most from an MDT evaluation are those diagnosed with A) cT3-4 disease (any age or comorbidity) or B) cT2 cancers if healthy and younger than 70 years or younger than 60 years with at least 1 comorbidity or C) cT1b if younger than 60 years and without comorbidities. Our findings can help selecting the optimal candidates for multidisciplinary evaluations and to consider RCC patients for clinical trials, deferred treatment, and treatment policy improvement. Also, our findings can be useful in the case of major healthcare disruptions, such as pandemics.

Validation of the prostate cancer comorbidity index in predicting cause-specific mortality in men undergoing radical prostatectomy.

Accurate prediction of competing risks of mortality remains a key component of prostate cancer treatment decision-making. We sought to validate the Prostate Cancer Comorbidity Index (PCCI) score for predicting other-cause mortality (OCM) and cancer outcomes in men undergoing radical prostatectomy (RP). We sampled 4857 men with prostate cancer treated with RP in the VA from 2000-2018. Risks of OCM, 90-day all-cause mortality (ACM), prostate cancer-specific mortality, metastasis, and biochemical recurrence by PCCI score were assessed using Cox proportional hazards and logistic regression. We compared prediction of 90-day ACM between PCCI and the American Society of Anesthesiology (ASA) score, a validated predictor of short-term mortality. Over median follow-up of 6.7 years (IQR 3.7-10.3), there was a stepwise increase in risk of OCM with higher PCCI score, with hazards (95%CI) of 1.53 (1.14-2.04), 2.11 (1.55-2.88), 2.36 (1.68-3.31), 3.61 (2.61-4.98), and 4.99 (3.58-6.96) for PCCI 1-2, 3-4, 5-6, 7-9, and 10 + (vs. 0), respectively. Projected 10-year cumulative incidence of OCM was 8%, 12%, 16%, 19%, 26%, and 32% for scores of 0, 1-2, 3-4, 5-6, 7-9, and 10+ , respectively. Men with PCCI 7+ had greater odds of 90-day ACM (OR 3.48, 95%CI 1.26-9.63) while men with higher ASA did not. Higher PCCI score was associated with worse cancer outcomes, with the highest categories driving the associations. The PCCI is a robust measure of short- and long-term OCM after RP, validated for use in clinical care and health services research focusing on surgical patient populations.

Oncologic Surveillance After Radical Nephroureterectomy for High-risk Upper Tract Urothelial Carcinoma

BackgroundThe appropriate surveillance protocol after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) is still poorly addressed. ObjectiveTo evaluate the appropriate intensity and duration of oncologic surveillance following RNU, according to a prior history of bladder cancer (BCa). Design, setting, and participantsWe identified 1378 high-risk UTUC patients, according to the European Association of Urology (EAU) guidelines, from a prospectively maintained database involving eight European referral centers. Surveillance protocol was based on cystoscopies and cross-sectional imaging, as per the EAU guidelines. Outcome measurements and statistical analysisFirst, we evaluated the noncumulative risk of bladder and other-site recurrences (including distant metastasis and locoregional relapse) against the follow-up time points, as suggested by the current EAU guidelines. Second, in an effort to identify the time points when the risk of other-cause mortality (OCM) exceeded that of recurrence and follow-up might be discontinued, we relied on adjusted Weibull regression. Results and limitationsThe median follow-up was 4 yr. A total of 427 and 951 patients with and without a prior BCa history, respectively, were considered. At 5-yr, the time point after which cystoscopies should be performed semiannually, the bladder recurrence risk was 10%; at 4 yr, the bladder recurrence risk was 13%. At 2 yr, the time point after which imaging should be obtained semiannually, the nonbladder recurrence risk was 42% in case of nonprior BCa and 47% in case of prior BCa; at 4 yr, the nonbladder recurrence risk was 23%. Among patients without a prior BCa history, individuals younger than 60 yr should continue both cystoscopies and imaging beyond 10 yr from RNU, 70–79-yr-old patients should continue only imaging beyond 10 yr, while patients older than 80 yr might discontinue oncologic surveillance because of an increased risk of OCM. Limitations include the fact that patients were treated and surveilled over a relatively long period of time. ConclusionsWe suggest intensifying the frequency of imaging to semiannual till the 4th year after RNU, the time point after which the risk of recurrence was almost halved. Cystoscopies could be obtained annually from the 4th year given a similar risk of recurrence at 4 and 5 yr after RNU. Oncologic surveillance could be discontinued in some cases in the absence of a prior BCa history. Patient summaryIn this study, we propose a revision of the current guidelines regarding surveillance protocols following radical nephroureterectomy. We also evaluated whether oncologic surveillance for high-risk upper tract urothelial carcinoma could be discontinued and, if so, in what circumstances.

MP47-18 SUSTAINABLE MULTIDISCIPLINARY TEAM REFERRAL FOR NON-METASTATIC RENAL CELL CARCINOMA: A SURVIVAL-BASED RECOMMENDATION

You have accessJournal of UrologyCME1 May 2022MP47-18 SUSTAINABLE MULTIDISCIPLINARY TEAM REFERRAL FOR NON-METASTATIC RENAL CELL CARCINOMA: A SURVIVAL-BASED RECOMMENDATION Giuseppe Basile, Alberto Martini, Giuseppe Fallara, Antony Pellegrino, Alessandro Larcher, Daniele Raggi, Riccardo Campi, Sumanta Pal, Philippe Spiess, Francesco Montorsi, Toni K. Choueiri, Andrea Necchi, and Umberto Capitanio Giuseppe BasileGiuseppe Basile More articles by this author , Alberto MartiniAlberto Martini More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Antony PellegrinoAntony Pellegrino More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Daniele RaggiDaniele Raggi More articles by this author , Riccardo CampiRiccardo Campi More articles by this author , Sumanta PalSumanta Pal More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Toni K. ChoueiriToni K. Choueiri More articles by this author , Andrea NecchiAndrea Necchi More articles by this author , and Umberto CapitanioUmberto Capitanio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002618.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To date, multidisciplinary team (MDT) evaluation, enrollment in pre-surgical trials and deferred active treatments are optional strategies for patients with Renal Cell Carcinoma (RCC), which are under investigation to maximize cancer control and implement health care policies. To provide recommendations regarding which patients with RCC may benefit the most from an early MDT evaluation. METHODS: We relied on a prospective dataset including patients diagnosed with RCC in 1998-2019 and treated by means of surgery alone at a tertiary referral center. The risk of other cause mortality (OCM) was evaluated against the risk of recurrence over time by means of the Weibull regression. Patients were stratified based on clinical stage (cT1a; cT1b; cT2; cT3-4), age (<60; 60-70; >70) and comorbidities [Charlson comorbidity index (CCI) 0 vs ≥1]. For each combination of cT stage, age and CCI, the potential need for a MDT referral was defined when the risk of recurrence exceeded the risk of OCM within the lower limit of the 95%CI of the mean time to recurrence. RESULTS: Overall, 1,162 (51%) patients had no comorbidities. Median follow-up was 7 years. Patients who would benefit most from a MDT evaluation are those diagnosed with A) cT3-4 disease (any age or comorbidity) or B) cT2 cancers if healthy and younger than 70 years or younger than 60 years with at least 1 comorbidity or C) cT1b if younger than 60 years and without comorbidities. Figure 1 depicts the risk of other cause mortality versus risk of recurrence following surgery for non-metastatic renal cell carcinoma according to age and cT stage in patients with no comorbidities or in presence of comorbidities. The continuous lines depict the risk of recurrence that decreases with time. Vertical lines depict the mean time to recurrence and associated 95% confidence interval calculated with mean restricted survival time. Dashed lines depict other cause mortality risk, which increases with time. CONCLUSIONS: Our findings can help selecting the optimal candidates for multidisciplinary evaluations and to consider RCC patients for clinical trials, deferred treatment, and treatment policy improvement, especially in the case of major healthcare disruptions, such as pandemics. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e817 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giuseppe Basile More articles by this author Alberto Martini More articles by this author Giuseppe Fallara More articles by this author Antony Pellegrino More articles by this author Alessandro Larcher More articles by this author Daniele Raggi More articles by this author Riccardo Campi More articles by this author Sumanta Pal More articles by this author Philippe Spiess More articles by this author Francesco Montorsi More articles by this author Toni K. Choueiri More articles by this author Andrea Necchi More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP32-15 COMPARISON OF THE PROSTATE CANCER COMORBIDITY INDEX AND AMERICAN ANESTHESIOLOGY ASSOCIATION SCORE IN PREDICTION OF MORTALITY IN MEN UNDERGOING RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II (MP32)1 Sep 2021MP32-15 COMPARISON OF THE PROSTATE CANCER COMORBIDITY INDEX AND AMERICAN ANESTHESIOLOGY ASSOCIATION SCORE IN PREDICTION OF MORTALITY IN MEN UNDERGOING RADICAL PROSTATECTOMY Michelle Chen, Lauren Howard, Shannon Stock, Anna Dolgner, Stephen Freedland, William Aronson, Martha Terris, Zachary Klaassen, Christopher Kane, Christopher Amling, Matthew Cooperberg, and Timothy Daskivich Michelle ChenMichelle Chen More articles by this author , Lauren HowardLauren Howard More articles by this author , Shannon StockShannon Stock More articles by this author , Anna DolgnerAnna Dolgner More articles by this author , Stephen FreedlandStephen Freedland More articles by this author , William AronsonWilliam Aronson More articles by this author , Martha TerrisMartha Terris More articles by this author , Zachary KlaassenZachary Klaassen More articles by this author , Christopher KaneChristopher Kane More articles by this author , Christopher AmlingChristopher Amling More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , and Timothy DaskivichTimothy Daskivich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002036.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Accurate prediction of competing risks of mortality is a key component of prostate cancer treatment decision-making. We sought to compare the Prostate Cancer Comorbidity Index (PCCI) with the American Society of Anesthesiology (ASA) score for predicting other-cause mortality (OCM) and cancer outcomes in men undergoing radical prostatectomy (RP). METHODS: We conducted an observational study of 4,857 men with prostate cancer treated with RP in the VA SEARCH database from 2000–2018. Risks of OCM, prostate cancer-specific mortality (PCSM), all-cause mortality (ACM), metastasis, and biochemical recurrence (BCR) by PCCI and ASA score were determined using Cox proportional hazards analysis. To compare risk discrimination, risks of OCM by PCCI were analyzed when stratified by ASA and vice versa. RESULTS: Our sample had a broad distribution of PCCI scores; 734 (15%), 1563 (32%), 996 (21%), 588 (12%), 559 (12%), and 417 (9%) men had PCCI scores of 1-2, 3-4, 5-6, 7-9, and 10+, respectively. ASA score had a narrow range, with 98% having scores of 2 or 3, requiring categorization by 1-2 vs. 3-4. Median follow up was 6.7 years (IQR 3.7-10.3). There was a stepwise increase in hazard of ACM and OCM with higher PCCI score (Figure 1). Men with PCCI 1-2, 3-4, 5-6, 7-9, and 10+ had hazards of OCM (95% CI) of 1.53 (1.14-2.04), 2.11 (1.55-2.88), 2.36 (1.68-3.31), 3.61 (2.61-4.98), and 4.99 (3.58-6.96), respectively. Men with ASA scores of 3-4 had a 1.96-fold (95% CI 1.65-2.33) higher hazard of OCM than those with scores of 1-2. Increases in PCCI score were associated with greater risk of ACM and OCM within ASA subgroups (p<0.001), while higher ASA was not uniformly associated with greater risk of ACM and OCM in PCCI subgroups. Higher PCCI but not ASA was associated with worse cancer outcomes, most notably those with the highest scores. Hazards (95% CI) of BCR, metastasis, and PCSM were 1.48 (1.18–1.84), 3.21 (1.69–6.12), and 3.56 (1.36–9.30), respectively, for those with PCCI of 10+ (vs 0). CONCLUSIONS: The PCCI is predictive of long-term OCM after RP, with improved granularity compared to the ASA. The association of higher PCCI with worse cancer outcomes may reflect relationships of older age and poorer health with more aggressive disease. Source of Funding: AUA Summer Medical Student Fellowship © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e571-e571 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michelle Chen More articles by this author Lauren Howard More articles by this author Shannon Stock More articles by this author Anna Dolgner More articles by this author Stephen Freedland More articles by this author William Aronson More articles by this author Martha Terris More articles by this author Zachary Klaassen More articles by this author Christopher Kane More articles by this author Christopher Amling More articles by this author Matthew Cooperberg More articles by this author Timothy Daskivich More articles by this author Expand All Advertisement Loading ...

Oncologic Surveillance for Variant Histology Bladder Cancer after Radical Cystectomy.

Presently, major guidelines do not provide specific recommendations on oncologic surveillance for patients who harbor variant histology (VH) bladder cancer (BCa) at radical cystectomy. We aimed to create a personalized followup scheme that dynamically weighs other cause mortality (OCM) vs the risk of recurrence for VH BCa, and to compare it with a similar one for pure urothelial carcinoma (pUC). Within a multi-institutional registry, 528 and 1,894 patients with VH BCa and pUC, respectively, were identified. The Weibull regression was used to detect the time points after which the risk of OCM exceeded the risk of recurrence during followup. The risk of OCM over time was stratified based on age and comorbidities, and the risk of recurrence on pathological stage and recurrence site. Individuals with VH had a higher risk of recurrence (recurrence-free survival 30% vs 51% at 10 years, p <0.001) and shorter median time to recurrence (88 vs 123 months, p <0.01) relative to pUC. Among VH, micropapillary variant conferred the greatest risk of recurrence on the abdomen and lungs, and mixed variants carried the greatest risk of metastasizing to bones and other sites compared to pUC. Overall, surveillance should be continued for a longer time for individuals with VH BCa. Notably, patients younger than 60 years with VH and pT0/Ta/T1/N0 at radical cystectomy should continue oncologic surveillance after 10 years vs 6.5 years for pUC individuals. VH BCa is associated with greater recurrence risk than pUC. A followup scheme that is valid for pUC should not be applied to individuals with VH. Herein, we present a personalized approach for surveillance that may allow an improved shared decision.

Abstract PS6-08: The PORTRET-tool: A prediction tool for older patients with breast cancer that predicts recurrence, survival and other-cause mortality

Abstract Introduction Previous studies have shown that available tools such as ‘Adjuvant Online!” are not able to accurately predict the prognosis of patients aged 65 years or older with breast cancer. Furthermore, all available tools predict prognosis in terms of recurrence-free survival or overall survival, whilst the risk of other-cause mortality is often high in the older patient with breast cancer. This is highly relevant as it may influence treatment decisions. Patient characteristics such as comorbidity and various geriatric variables have shown to be predictive for these outcomes and could enhance the precision of prognostic tools for this target population. The objective of this study was to develop a prediction tool for recurrence, survival and other-cause mortality for older patients with breast cancer who received locoregional treatment, with incorporation of patient-, tumor- and geriatric variables. The tool additionally predicts expected benefits of systemic treatment. Methods Data from the large population-based FOCUS cohort was used, consisting of consecutive breast cancer patients in the South-Western part of the Netherlands, diagnosed between 1997 and 2004, aged 65 years and older. It contains detailed information on tumor characteristics, treatment, comorbidity and geriatric parameters. We developed a risk prediction model using a Cox proportional hazards regression model for overall survival and cause-specific Cox proportional hazards models for recurrence and other-cause mortality (defined as mortality without recurrence). The included predictors were derived from the PREDICT tool (consisting of age and various tumor variables), since this tool was previously shown to have the best performance in older adults so far. Predictors were complemented with comorbidity and geriatric variables. Discrimination accuracy was evaluated using time-dependent area under the curve (AUC). The potential annual benefit of chemotherapy was calculated assuming a relative risk of chemotherapy on recurrence of 0.7, derived from data from the most recent updates of the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Additional benefit of endocrine treatment will be included in further development of the tool. Results A total of 2,744 patients were included for the initial development. For all patients, 5-year follow-up was complete with a high event-rate including 343 recurrences and 831 total deaths of which 586 without recurrence. The strongest predictors for overall survival and non-recurrence mortality were age (HR = 2.14, 95% CI: 1.89 - 2.43 and HR = 2.87, 95% CI: 2.46 - 3.35, respectively) and dementia (HR = 1.52, 95% CI: 1.16 - 1.99 and HR = 1.9, 95% CI: 1.49 - 2.65, respectively), and for recurrence, nodal status (HR = 1.80, 95% CI: 1.45 - 2.24) and tumor grade (HR = 2.96, 95% CI: 1.88 - 4.66). The time-dependent AUC at 5 years for recurrence-specific and other-cause mortality were 0.78 (95% CI: 0.76 - 0.81), and 0.75 (95% CI: 0.72 - 0.78), respectively. The AUC for overall survival was 0.75 (95% CI: 0.72 - 0.78). External validation is currently being performed in a large dataset retrieved from the national cancer registry (N= 13,631). These results will be presented during the symposium. Conclusion We have developed a model for predicting 5-year recurrence, other-cause mortality and overall survival, including expected benefits of adjuvant treatment, for older patients with breast cancer, with a good discrimination performance within a large-population based cohort. To our knowledge, this is the first model specifically designed for the older population, including competing risk as a predicted outcome and with incorporation of geriatric variables. Citation Format: Willeke van der Plas-Krijgsman, Daniele Giardiello, Hein Putter, Ewout W Steyerberg, Esther Bastiaannet, Anne M Stiggelbout, Simon P Mooijaart, Johanneke EA Portielje, Gerrit J Liefers, Nienke A de Glas. The PORTRET-tool: A prediction tool for older patients with breast cancer that predicts recurrence, survival and other-cause mortality [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-08.

Differences between rural and urban prostate cancer patients

BackgroundWe hypothesized that the residency status (rural area [RA] vs urban clusters [UC] vs urban areas [UA]) affects stage and cancer-specific mortality (CSM) in contemporary newly diagnosed prostate cancer (PCa) patients of all stages, regardless of treatment.MethodsNewly diagnosed PCa patients with available residency status were abstracted from the Surveillance, Epidemiology, and End Results database (2004–2016). Propensity-score (PS) matching, cumulative incidence plots, multivariate competing-risks regression (CRR) models were used.ResultsOf 531,468 PCa patients of all stages, 6653 (1.3%) resided in RA, 50,932 (9.6%) in UC and 473,883 (89.2%) in UA. No statistically significant or clinically meaningful differences in stage at presentation or CSM were recorded. Conversely, 10-year other cause-mortality (OCM) rates were 27.2% vs 23.7% vs 18.9% (p < 0.001) in RA vs UC vs UA patients, respectively. In CRR models, RA (subhazard ratio [SHR] 1.38; p < 0.001) and UC (SHR 1.18; p < 0.001) were independent predictors for higher OCM relative to UA. These differences remained statistically significant in fully PS-adjusted multivariate CRR models.ConclusionRA, and to a lesser extent UC, PCa patients are at higher risk of OCM than UA patients. Higher OCM may indicate shorter life expectancy and should be considered in treatment decision making.

Rates of other-cause mortality after radical cystectomy are decreasing over time-A population-based analysis over two decades.

To investigate other-cause mortality (OCM) rates over time according to several baseline characteristics in bladder cancer (BCa) patients treated with radical cystectomy (RC). Within the Surveillance, Epidemiology, and End Results database (1988-2011), we identified 7702 T1-2 N0 M0 urothelial BCa patients treated with RC. Temporal trends and multivariable Cox regression (MCR) analyses assessed 5-year OCM. Data were stratified according to the year of diagnosis (1988-1995 vs 1996-2000 vs 2001-2004 vs 2005-2008 vs 2009-2011), age group (<60 vs 60-75 vs >75 years), sex, race, marital status, and socioeconomic status. Overall, OCM rates decreased from 13.9% in 1988-1995 to 8.6% in 2009-2011. The greatest decrease was recorded in elderly (>75) patients (32%-16%, slope: -0.55% per year; P = .01), followed by patients aged 60 to 75 (21%-5%, slope: -0.35% per year; P = .01), unmarried patients (16%-10%, slope: -0.26% per year; P < .001), male patients (14%-8.9%, slope: -0.23% per year), and African Americans (16%-11%, slope: -0.27% per year; P < .001). MCR models corroborated these results. Most important decrease in OCM after RC over the last decades was recorded in the elderly, unmarried, and male patients. Nonetheless, these three patient groups still represent ideal targets for efforts aimed at minimizing the morbidity and mortality after RC, as their risk of OCM is higher than in others.

Effects of age and comorbidity on survival vary according to risk grouping among patients with prostate cancer treated using radical prostatectomy

A multicenter Korean Prostate Cancer Database (K-CaP) has been established to provide information regarding Korean patients with prostate cancer (PCa). We used the K-CaP registry to investigate the value of age and comorbidity for predicting cancer-specific mortality (CSM) and other-cause mortality (OCM) according to risk grouping.The K-CaP registry includes 2253 patients who underwent radical prostatectomy (RP) between May 2001 and April 2013 at 5 institutions. Preoperative clinicopathologic data were collected and stratified according to the National Comprehensive Cancer Network risk criteria. Survival was evaluated using Gray's modified log-rank test according to risk category, age (<70 years vs ≥70 years), and Charlson comorbidity index (CCI) (0 vs ≥1).The median follow-up was 55.0 months (interquartile range: 42.0–70.0 months). Competing-risk regression analysis revealed that, independent of CCI, ≥70-year-old high-risk patients had significantly greater CSM than <70-year-old high-risk patients (P = .019). However, <70-year-old high-risk patients with a CCI of ≥1 had similar CSM relative to ≥70-year-old patients. Survival was not affected by age or CCI among low-risk or intermediate-risk patients. Multivariate analysis revealed that a CCI of ≥1 was independently associated with a higher risk of CSM (P = .003), while an age of ≥70 years was independently associated with a higher risk of OCM (P = .005).Age and comorbidity were associated with survival after RP among patients with high-risk PCa, although these associations were not observed among low-risk or intermediate-risk patients. Therefore, older patients with high-risk diseases and greater comorbidity may require alternative multidisciplinary treatment.

PD72-05 NATURAL HISTORY OF PATIENTS TREATED WITH SALVAGE RADIATION THERAPY FOR RISING PSA AFTER RADICAL PROSTATECTOMY: A LONG-TERM SURVIVAL ANALYSIS

PD72-05 NATURAL HISTORY OF PATIENTS TREATED WITH SALVAGE RADIATION THERAPY FOR RISING PSA AFTER RADICAL PROSTATECTOMY: A LONG-TERM SURVIVAL ANALYSIS

Cancer-Specific Mortality Among Korean Men with Localized or Locally Advanced Prostate Cancer Treated with Radical Prostatectomy Versus Radiotherapy: A Multi-Center Study Using Propensity Scoring and Competing Risk Regression Analyses.

PurposeStudies comparing radical prostatectomy (RP) outcomes with those of radiotherapy with or without androgen deprivation therapy (RT±ADT) for prostate cancer (PCa) have yielded conflicting results. Therefore, we used propensity score-matched analysis and competing risk regression analysis to compare cancer-specific mortality (CSM) and other-cause mortality (OCM) between these two treatments.Materials and MethodsThe multi-center, Severance Urological Oncology Group registry was utilized to identify 3,028 patients with clinically localized or locally advanced PCa treated by RP (n=2,521) or RT±ADT (n=507) between 2000 and 2016. RT±ADT cases (n=339) were matched with an equal number of RP cases by propensity scoring based on age, preoperative prostate-specific antigen, clinical tumor stage, biopsy Gleason score, and Charlson Comorbidity Index (CCI). CSM and OCM were co-primary endpoints.ResultsMedian follow-up was 65.0 months. Five-year overall survival rates for patients treated with RP and RT±ADT were 94.7% and 92.0%, respectively (p=0.105). Cumulative incidence estimates revealed comparable CSM rates following both treatments within all National Comprehensive Cancer Network risk groups. Gleason score ≥ 8 was associated with higher risk of CSM (p=0.009). OCM rates were comparable between both groups in the low- and intermediate-risk categories (p=0.354 and p=0.643, respectively). For high-risk patients, RT±ADT resulted in higher OCM rates than RP (p=0.011). Predictors of OCM were age ≥ 75 years (p=0.002) and CCI ≥ 2 (p < 0.001).ConclusionRP and RT±ADT provide comparable CSM outcomes in patients with localized or locally advanced PCa. The risk of OCM may be higher for older high-risk patients with significant comorbidities.

Impact of comorbidity and PSA doubling time on the risk of death in men experiencing PSA failure following radiation therapy with or without androgen deprivation therapy for unfavorable-risk prostate cancer.

68 Background: The optimal management of men with PSA failure following initial prostate cancer therapy based on comorbidity is unknown. We investigated the impact that PSA doubling time (DT) and comorbidity had on the risk of all cause (AC), prostate cancer-specific (PCS) and other cause mortality (OCM) following PSA failure. Methods: Between 1995 and 2001, 206 men with unfavorable-risk PC were randomized to receive radiation therapy alone or in combination with 6 months of androgen deprivation therapy (ADT). After a median follow up of 16.2 years, 108 men experienced PSA failure (85, no or minimal; 23, moderate to severe comorbidity) and formed the study cohort. Cox and Fine-Gray regression analysis was used to determine whether PSA DT was associated with the risk of ACM and PCSM/OCM respectively, stratified by ACE-27 comorbidity score. Results: After a median follow up of 13.71 years following PSA failure, 81 of the 108 men (75%) died. Longer PSA DT was associated with a decreased risk of PCSM in men with no/minimal (AHR 0.33, 95% CI 0.17-0.65, p= 0.001) and moderate/severe comorbidity (AHR 0.014, 95% CI 0.002-0.129, p= 0.0002) with a trend toward an increased risk of OCM in men with no/minimal (AHR 1.42, 95% CI 0.94-2.16, p= 0.10) and moderate/severe comorbidity (AHR 1.68, 95% CI 0.85-3.35, p= 0.14). However, increasing PSA DT was only associated with a decreased risk of ACM in men with no/minimal (AHR 0.69, 95% CI 0.50-0.96, p = 0.03) but not moderate/severe comorbidity (AHR 0.95, 95% CI 0.51-1.78, p= 0.87). Conclusions: The extent and natural history of comorbidity as well as PSA DT should be taken into consideration when deciding on appropriate management and/or clinical trial eligibility at the time of PSA failure. Specifically, randomized studies are needed to determine whether survival is prolonged in men with life-shortening comorbidity with salvage ADT at the time of PSA failure versus surveillance and reserving ADT use for symptomatic progression. For all other men, trials comparing ADT with or without novel agents shown to prolong survival in men with metastatic castrate resistant PC is warranted.

The impact of comorbidity and PSA doubling time on the risk of death in men experiencing PSA failure following radiation therapy with or with androgen deprivation therapy for unfavorable-risk prostate cancer.

The optimal management of men with PSA failure following initial prostate cancer (PC) therapy stratified by comorbidity is unknown. We investigated the impact that PSA doubling time (DT) and comorbidity had on the risk of all-cause mortality (ACM), prostate cancer-specific mortality (PCSM) and other-cause mortality (OCM) following PSA failure. Between 1995 and 2001, 206 men with unfavorable-risk PC were randomized to receive radiation therapy alone or in combination with 6 months of androgen deprivation therapy (ADT); 108 men experienced PSA failure and formed the study cohort. Cox and Fine-Gray regression analysis was used to determine whether PSA DT was associated with the risk of ACM and PCSM/OCM, respectively, stratified by comorbidity status using a validated metric. After a median follow-up of 13.71 years following PSA failure, 81 of the 108 men (75%) died. Longer PSA DT was associated with a decreased riskof PCSM inmen with no/minimal (adjusted hazard ratio (AHR) 0.33, 95% confidence interval (CI) 0.17-0.65, P=0.001) and moderate/severe comorbidity (AHR 0.014, 95% CI 0.002-0.129, P=0.0002). However, because of the different contributions of the risk of OCM to risk of ACM within comorbidity subgroups, increasing PSA DT was onlyassociated with a decreased risk of ACM in men with no/minimal (AHR 0.69, 95% CI 0.50-0.96, P=0.03) butnot moderate/severe comorbidity (AHR 0.95, 95% CI 0.51-1.78, P=0.87). Both the extent of comorbidity and the PSA DT should be taken into consideration when deciding on appropriate management and/or clinical trial eligibility at the time of PSA failure.

Elective Nephron Sparing Surgery Decreases Other Cause Mortality Relative to Radical Nephrectomy Only in Specific Subgroups of Patients with Renal Cell Carcinoma

There is no consensus regarding a protective effect on mortality due to a cause other than cancer in patients treated with elective nephron sparing surgery relative to their radical nephrectomy counterparts. We test whether the protective effect of nephron sparing surgery relative to radical nephrectomy is universal or present in specific subgroups of patients. A collaborative database of 5 institutions was queried to evaluate 1,783 patients without chronic kidney disease diagnosed with a clinical T1 renal mass that was treated with nephron sparing surgery or radical nephrectomy. Multivariable Cox regression analysis was done to assess the impact of surgery type (nephron sparing surgery vs radical nephrectomy) on other cause mortality after adjustment for patient and cancer characteristics. Interaction terms were used to test the hypothesis that the impact of surgery type varies according to specific subcohorts of patients. Ten-year other cause mortality-free survival rates were 90% and 88% after nephron sparing surgery and radical nephrectomy, respectively. In the overall population radical nephrectomy was not associated with an increased risk of other cause mortality on multivariable analysis compared to nephron sparing surgery (HR 0.91, 95% CI 0.6-1.38, p = 0.6). However, radical nephrectomy increased the risk of other cause mortality according to the increasing baseline Charlson comorbidity index (interaction test p = 0.0008). For example, in a patient with a Charlson comorbidity index of 4 the probability of 10-year other cause mortality-free survival was 86% after nephron sparing surgery and 60% after radical nephrectomy. Elective nephron sparing surgery does not improve other cause survival relative to radical nephrectomy consistently in all patients with kidney cancer. Patients who are more ill with relevant comorbidities are those who benefit the most from nephron sparing surgery in terms of other cause mortality.

Medical androgen deprivation therapy and increased non-cancer mortality in non-metastatic prostate cancer patients aged ≥66 years

PurposeTo examine the potential relationship between androgen deprivation therapy and other-cause mortality (OCM) in patients with prostate cancer treated with medical primary-androgen deprivation therapy, prostatectomy, or radiation. MethodsA total of 137,524 patients with non-metastatic PCa treated between 1995 and 2009 within the Surveillance Epidemiology and End Results Medicare-linked database were included. Cox-regression analysis tested the association of ADT with OCM. A 40-item comorbidity score was used for adjustment. ResultsOverall, 9.3% of patients harbored stage III–IV disease, and 57.7% of patients received ADT. The mean duration of ADT exposure was 22.9 months (median: 9.1; IQR: 2.8–31.5). Mean and median follow-up were 66.9, and 60.4 months, respectively. At 10 years, overall-OCM rate was 36.5%; it was 30.6% in patients treated without ADT vs. 40.1% in patients treated with ADT (p < 0.001). In multivariable-analysis, ADT was associated with an increased risk of OCM (Hazard-ratio [HR]: 1.11, 95% Confidence-interval [95% CI]: 1.08–1.13). Patients with no comorbidity (10-year OCM excess risk: 9%) were more subject to harm from ADT than patients with high comorbidity (10-year OCM excess risk: 4.7%). ConclusionsIn patients with PCa, treatment with medical ADT may increase the risk of mortality due to causes other than PCa. Whether this is a simple association or a cause–effect relationship is unknown and warrants further study in prospective studies.

MP73-11 ANDROGEN DEPRIVATION THERAPY AND INCREASED NON-CANCER MORTALITY IN PROSTATE CANCER PATIENTS: ANALYSIS OF THE NUMBER NEEDED TO TREAT

You have accessJournal of UrologyProstate Cancer: Advanced I1 Apr 2015MP73-11 ANDROGEN DEPRIVATION THERAPY AND INCREASED NON-CANCER MORTALITY IN PROSTATE CANCER PATIENTS: ANALYSIS OF THE NUMBER NEEDED TO TREAT Firas Abdollah, Jesse Sammon, Akshay Sood, Daniel Pucheril, Dane Klett, Maxine Sun, Ayal Aizer, Toni Choueiri, Jim Hu, Simon Kim, Adam Kibel, Paul Nguyen, Mani Menon, and Quoc-Dien Trinh Firas AbdollahFiras Abdollah More articles by this author , Jesse SammonJesse Sammon More articles by this author , Akshay SoodAkshay Sood More articles by this author , Daniel PucherilDaniel Pucheril More articles by this author , Dane KlettDane Klett More articles by this author , Maxine SunMaxine Sun More articles by this author , Ayal AizerAyal Aizer More articles by this author , Toni ChoueiriToni Choueiri More articles by this author , Jim HuJim Hu More articles by this author , Simon KimSimon Kim More articles by this author , Adam KibelAdam Kibel More articles by this author , Paul NguyenPaul Nguyen More articles by this author , Mani MenonMani Menon More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2687AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In prostate cancer (PCa) patients, the relationship between androgen deprivation therapy (ADT) and other-cause mortality (OCM), and the magnitude of this potential relationship has not been fully elucidated. The objective of this study is to examine and quantify the association of ADT with OCM in PCa patients treated with primary ADT, prostatectomy, or radiation. METHODS A total of 137,524 patients with non-metastatic PCa treated between 1995 and 2009 within the Surveillance Epidemiology and End Results Medicare-linked database were included. Cox-regression analysis and the number needed to harm (NNH) were used to respectively test and quantify the association of ADT with OCM. A 40-item comorbidity score was used for adjustment. RESULTS Overall, 9.3% of patients harbored stage III-IV disease, and 57.7% of patients received ADT. The mean duration of ADT exposure was 22.9 months (median: 9.1; IQR: 2.8-31.5). Mean and median follow-up were 66.9, and 60.4 months, respectively. At 10 years, overall OCM rate was 36.5%; it was 30.6% in patients treated without ADT vs. 40.1% in patients treated with ADT (p<0.001). This translated into a number need to harm (NNH) of 10.5. In multivariable analysis, ADT was associated with an increased risk of OCM (hazard ratio: 1.11, 95% confidence interval: 1.08-1.13). Patients with no comorbidity (10-year NNH: 11.1) were more subject to harm from ADT than patients with high comorbidity (10-year NNH: 21.3). CONCLUSIONS In patients with PCa, treatment with ADT may increase the risk of mortality due to causes other than prostate cancer. The NNH was 10.5. Whether this is a simple association or a cause-effect relationship is unknown and warrants further study in prospective studies. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e934 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Firas Abdollah More articles by this author Jesse Sammon More articles by this author Akshay Sood More articles by this author Daniel Pucheril More articles by this author Dane Klett More articles by this author Maxine Sun More articles by this author Ayal Aizer More articles by this author Toni Choueiri More articles by this author Jim Hu More articles by this author Simon Kim More articles by this author Adam Kibel More articles by this author Paul Nguyen More articles by this author Mani Menon More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

MP44-04 NEPHRON-SPARING SURGERY PROTECTS FROM CHRONIC KIDNEY DISEASE RELATIVE TO RADICAL NEPHRECTOMY BUT DOES NOT IMPACT ON OTHER-CAUSES MORTALITY: LONG-TERM (MORE THAN 10 YEARS) SURVIVAL AND FUNCTIONAL OUTCOMES IN PATIENTS WITH A T1A-T1B RENAL MASS

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging II1 Apr 2015MP44-04 NEPHRON-SPARING SURGERY PROTECTS FROM CHRONIC KIDNEY DISEASE RELATIVE TO RADICAL NEPHRECTOMY BUT DOES NOT IMPACT ON OTHER-CAUSES MORTALITY: LONG-TERM (MORE THAN 10 YEARS) SURVIVAL AND FUNCTIONAL OUTCOMES IN PATIENTS WITH A T1A-T1B RENAL MASS Umberto Capitanio, Carlo Terrone, Alessandro Antonelli, Andrea Minervini, Cristian Fiori, Luisa Zegna, Maria Furlan, Giorgio Gandaglia, Paolo Capogrosso, Carini Marco, Claudio Simeone, Roberto Bertini, and Francesco Montorsi Umberto CapitanioUmberto Capitanio More articles by this author , Carlo TerroneCarlo Terrone More articles by this author , Alessandro AntonelliAlessandro Antonelli More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Cristian FioriCristian Fiori More articles by this author , Luisa ZegnaLuisa Zegna More articles by this author , Maria FurlanMaria Furlan More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Carini MarcoCarini Marco More articles by this author , Claudio SimeoneClaudio Simeone More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , and Francesco MontorsiFrancesco Montorsi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1546AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several reports demonstrated that nephron sparing surgery (NSS) better protects renal function relative to radical nephrectomy (RN). However, controversies exist whether NSS may also affect other-cause mortality (OCM). In the current study, we aimed to report the long term (more than 10 years) survival and functional outcomes of NSS vs. RN after accounting for clinical characteristics, comorbidities and individual patients' cardiovascular risk. METHODS A collaboration among five centers allowed collecting 1189 patients with a clinical T1a-T1bN0M0 renal mass (1988-2004). Patients underwent RN (n=678, 57%) or NSS (n=511, 43%) and showed normal estimated glomerular filtration rates (eGFR) before surgery (defined as eGFR≥60). Descriptive and Cox regression analyses were used to predict the risk of OCM and chronic kidney disease (CKD, defined as post-operative GFR<60). To adjust for inherent baseline differences among patients, we included as covariates: age, pre-operative GFR, clinical tumor size, hypertension (none vs. yes vs. controlled by medical therapy), diabetes, baseline Charlson comorbidity index (CCI), body mass index and smoker status. RESULTS Median follow up period was 10 years. Median age was 61 yrs (IQR 51-68). Sixty-six (5.6%) patients had diabetes. Overall, 141 (11.9%) and 154 (13.0%) patients had hypertension or hypertension controlled by medical therapy, respectively. CCI resulted 2 or higher in 21% of the cases. The 5 yr, 10 yr and 15 yr CKD rates after surgery were 6.3%, 16.4% and 42.3% for NSS vs. 13.2%, 28.4% and 48.9% for RN, respectively (p=0.002, HR 0.65 95%CI 0.49-0.85). At multivariable analyses, patients who underwent NSS showed significantly lower risk to harbour CKD compared with their RN-treated counterparts (p=0.01, HR 0.65; 95%CI, 0.47-0.92). The 5 yr, 10 yr and 15 yr OCM rates after surgery were 6.0%, 14.0% and 26.6% for NSS vs. 7.3%, 14.2% and 22.5% for RN, respectively (p=0.6, HR 1.08 95%CI 0.80-1.46). At multivariable analyses, after accounting for clinical characteristics, comorbidities and individual cardiovascular risk, patients who underwent NSS showed similar risk to die for OCM compared with their RN-treated counterparts (p=0.8, HR 0.97 95%CI 0.67-1.40). CONCLUSIONS When considering long-term survival and functional outcomes in patients with a clinical T1a-T1b mass and normal renal function before surgery, NSS protects from CKD but does not impact on OCM relative to RN. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byZabell J, Demirjian S, Lane B, Derweesh I, Isharwal S, Suk-Ouichai C, Wu J, Palacios D and Campbell S (2018) Predictors of Long-Term Survival after Renal Cancer SurgeryJournal of Urology, VOL. 199, NO. 2, (384-392), Online publication date: 1-Feb-2018.Laguna M (2018) Re: End-Stage Renal Disease after Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at BaselineJournal of Urology, VOL. 197, NO. 5, (1214-1215), Online publication date: 1-May-2017. Volume 193Issue 4SApril 2015Page: e527 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Umberto Capitanio More articles by this author Carlo Terrone More articles by this author Alessandro Antonelli More articles by this author Andrea Minervini More articles by this author Cristian Fiori More articles by this author Luisa Zegna More articles by this author Maria Furlan More articles by this author Giorgio Gandaglia More articles by this author Paolo Capogrosso More articles by this author Carini Marco More articles by this author Claudio Simeone More articles by this author Roberto Bertini More articles by this author Francesco Montorsi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...