Artikel
Short to mid-term mortality of prostatectomy vs. radiotherapy as a primary treatment for prostate cancer
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Autoren
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Daniel Medenwald
- Martin-Luther-Universität Halle-Wittenberg, Klinik für Strahlentherapie und Institut für Medizinische Epidemiologie, Biometrie und Informatik, Halle (Saale)
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Dirk Vordermark
- Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Klinik für Strahlentherapie, Halle (Saale)
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Christian Dietzel
- Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Klinik für Strahlentherapie, Halle (Saale)
| Veröffentlicht: | 12. Oktober 2018 |
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Gliederung
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Objective: To assess the extent of short to mid-term mortality and its temporal course after prostatectomy and radiotherapy in the general population.
Methods: Data from SEER-database and German epidemiologic cancer registries were used for the years 2005-2013. Metastasized cases and deaths from bladder cancer were excluded (avoiding incidental cases after bladder cancer).
Analysing overall mortality, year-specific Cox regression models were used for German and US-American data 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
Results: In the German and the US-American population we observed higher mortality hazards for prostatectomy (USA: 7.2-fold risk, 95% CI: 5.5-9.5; Germany: 6.2, 95% CI: 3.7-10.1) decreasing to a plateau with inverse risk ratios not before 20 months after diagnosis (used as a cut-off for the observational period defining the initial mortality phase).
During the observational period we observed an increasing hazard ratio for the 20-month mortality in the German population (2005: 1.5, 95% CI: 1.0-2.3; 2013: 3.1, 95% CI: 2.0-4.8). In the US-population the effect remained virtually constant (2005: 1.2, 95% CI: 1.1-1.3; 2013: 1.3, 95% CI: 1.1-1.5). Considering low-risk cases, the adverse surgery effect appeared stronger (2005: 2.2, 95% CI: 1.7-2.9; 2013: 3.8, 95% CI: 2.4-6.0).
Conclusion: There is strong evidence from two populations of a higher short to mid-term mortality after prostatectomy compared to radiotherapy extending the time of early mortality considered by previous studies up to 20 months.
