Impact of age, comorbidity, and PSA doubling time on long-term competing risks for mortality among men with non-metastatic castration-resistant prostate cancer

Whitney, Colette; Howard, Lauren E.; Freedland, Stephen J.; Hoedt, Amanda M. De; Amling, Christopher L.; Aronson, William J.; Cooperberg, Matthew R.; Kane, Christopher J.; Terris, Martha K.; Daskivich, Timothy J.

doi:10.1038/s41391-018-0095-0

Cited by 29 publications

(23 citation statements)

References 24 publications

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“…Wei S et al found surgery (except for lobectomy or bilobectomy) conferred an increased risk of OCSM when compared with no surgery, despite the main study population being NSCLC rather than ASC. Additionally, in contrast with younger patients, elderly patients were more exposed to severe comorbidities [25,26], and comorbidities have been demonstrated as a strong predictor of OCSM in various cancers [9][10][11]. Therefore, for elderly patients with severe comorbidities, surgery might not be a favorable treatment means, allowing for the high risk of OCSM.…”

Section: Discussionmentioning

confidence: 99%

“…A majority of ASC patients are diagnosed at an age over 60 years [3,6,7], and elderly patients tend to have a higher prevalence of comorbidity than younger patients [8]. In addition, comorbidity has been proved to be a strong predictor of other cause-specific mortality (OCSM) in various cancers [9][10][11]. In light of the high risk of OCSM, it is essential to take OCSM into account when performing survival analysis for lung ASC.…”

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confidence: 99%

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Competing Risk Nomograms Predicting Cause-specific Mortality and Competing Mortality in Patients with Lung Adenosquamous Carcinoma

Xiao

Petersen

et al. 2020

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Background Adenosquamous carcinoma (ASC) is an uncommon histological subtype of lung cancer. The purpose of this study was to assess the cumulative incidence of lung cancer-specific mortality (LC-SM) and other cause-specific mortality (OCSM) for lung ASC patients, and construct the corresponding competing risk nomograms. Methods Data on 2,705 patients with first primary lung ASC histologically diagnosed during 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Cumulative incidence function (CIF) was utilized to calculate the 3-year and 5-year probabilities of LC-SM and OCSM, and a competing risk model was built. Based on the model, we developed the competing risk nomograms, and the corresponding concordance indexes ( C -index) and calibration curves were derived to assess the model performance. Results The 3-year and 5-year cumulative mortalities were 49.6% and 55.8% for LC-SM, and 8.2% and 11.8% for OCSM, respectively. In multivariate analysis, increasing age, male sex, no surgery, and advanced T, N and M stage were related to a significantly higher likelihood of LC-SM, in contrast with increasing age and surgery served as predictors for an elevated risk of OCSM. The nomogram showed a good calibration, and the 5-year C-indexes for predicting probabilities of LC-SM and OCSM in the validation cohort were 0.79 and 0.63, respectively. Conclusions The competing risk nomogram displayed an excellent discrimination and calibration, especially for predicting LC-SM. With the aid of this individualized predictive tool, it is more expedient for clinicians to devise appropriate treatment protocols and follow-up schedules.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Competing Risk Nomograms Predicting Cause-specific Mortality and Competing Mortality in Patients with Lung Adenosquamous Carcinoma

Xiao

Petersen

et al. 2020

Preprint

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“…After obtaining institutional review board approval (IRB#00340), data on patients who underwent RRP or RALP from 1988 to 2017 at eight Veterans Affairs Medical Centers in West Los Angeles, San Diego, San Francisco, and Palo Alto, California; Portland, Oregon; Durham and Asheville, North Carolina; and Augusta, Georgia, were entered into the SEARCH database 9 . This database includes patient characteristics at the time of surgery, including age, surgery year, race, BMI, preoperative PSA, surgical approach (RRP vs RALP), hospital annual surgical RP volume, grade of cancer on diagnostic biopsies and surgical specimen pathology (specimen weight, tumor grade, surgical margin status, evidence of extracapsular extension and lymph node involvement).…”

Section: Methodsmentioning

confidence: 99%

Obese men undergoing radical prostatectomy: Is robotic or retropubic better to limit positive surgical margins? Results from SEARCH

et al. 2020

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Objectives: To evaluate the association between obesity and positive surgical margins in patients undergoing retropubic radical prostatectomy versus robotic-assisted laparoscopic prostatectomy. Methods: We retrospectively reviewed the data of 3141 men undergoing retropubic radical prostatectomy and 1625 undergoing robotic-assisted laparoscopic prostatectomy between 1988 and 2017 at eight Veterans Health Administration hospitals. The positive surgical margin location (peripheral, apical, bladder neck, overall) was determined from pathology reports. We adjusted for age, race, prostate-specific antigen, surgery year, prostate weight, pathological grade group, extracapsular extension, seminal vesicle invasion, hospital surgical volume and surgical method (in analyses not stratified by surgical method). Interactions between body mass index and surgical approach were tested. Results: Among all patients, higher body mass index was associated with increased odds of overall, peripheral and apical positive surgical margins (OR 1.02-1.03, P ≤ 0.02). Although not statistically significant, there was a trend between higher body mass index and increased odds of bladder neck positive surgical margins (OR 1.03, P = 0.09). Interactions between body mass index and surgical method were significant for peripheral positive surgical margins only (P = 0.024). Specifically, there was an association between body mass index and peripheral positive surgical margins among men undergoing retropubic radical prostatectomy (OR 1.04, P < 0.001), but not roboticassisted laparoscopic prostatectomy (OR 1.00, P = 0.98). Limitations include lacking individual surgeon data and lacking central pathology review. Conclusions: In this multicenter cohort, higher body mass index was associated with increased odds of positive surgical margins at all locations except the bladder neck. Furthermore, there was a significant association between obesity and peripheral positive surgical margins in men undergoing retropubic radical prostatectomy, but not roboticassisted laparoscopic prostatectomy. Long-term clinical significance requires further study.

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“…After obtaining Institutional Review Board approval, data from patients undergoing radical prostatectomy (RP; n=7,811) from 1982-2017 at eight Veterans Administration (VA) Medical Centers were combined into the SEARCH database. 11 SEARCH does not include patients treated with preoperative ADT or radiation therapy. Given our goal to understand if serum lipids at ADT were associated with CRPC or metastasis risk, we excluded patients who never received ADT (n=6,466).…”

Section: Study Samplementioning

confidence: 99%

Serum Lipids prior to Starting Androgen Deprivation Therapy and Risk of Castration Resistant Prostate Cancer and Metastasis: Results from the SEARCH Database

et al. 2020

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To test the association between serum lipid levels prior to androgen deprivation therapy (ADT) and risk of CRPC and metastasis. Materials and methods: We identified 302 men in the SEARCH database who received ADT after radical prostatectomy for non-metastatic disease, never used statins before ADT, and had available serum lipid data within two years prior to ADT. Cox proportional hazards models were used to test associations between total cholesterol (<200 vs. ≥200 mg/dl), low-density lipoprotein (LDL; <130 vs. ≥130 mg/dl), high-density lipoprotein (HDL; ≥40 vs. <40 mg/dl) and triglycerides (<150 vs. ≥150 mg/dl) and risk of CRPC and metastasis after ADT, adjusting for potential confounders. In subanalyses, we restricted to men who remained statin non-users post-ADT. Results: Median follow-up was 67 months; 42 men developed CRPC and 44 metastasis. Men with elevated cholesterol had earlier ADT year and longer follow-up, and higher rates of statin use post-ADT. In multivariable analysis, total cholesterol and LDL were unrelated to CRPC. Low HDL (<40 vs. ≥40mg/dL) was suggestively linked with increased risk of CRPC (HR 1.86; 95%CI 0.99-3.48), with a stronger association in men who remained statin non-users post-ADT (HR 3.64; 95%CI 1.45-9.17). Results for metastasis were similar to those found for CRPC. Conclusions: Among men with non-metastatic prostate cancer starting ADT, serum cholesterol was unrelated to CRPC or metastasis. Low HDL was suggestively associated with increased CRPC and metastasis risk, particularly in statin never-users. Further studies are needed to explore a potential role for lipids in prostate cancer progression after ADT. HDL ≥40 mg/dL <40 mg/dL Continuous §

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Impact of age, comorbidity, and PSA doubling time on long-term competing risks for mortality among men with non-metastatic castration-resistant prostate cancer

Cited by 29 publications

References 24 publications

Competing Risk Nomograms Predicting Cause-specific Mortality and Competing Mortality in Patients with Lung Adenosquamous Carcinoma

Competing Risk Nomograms Predicting Cause-specific Mortality and Competing Mortality in Patients with Lung Adenosquamous Carcinoma

Obese men undergoing radical prostatectomy: Is robotic or retropubic better to limit positive surgical margins? Results from SEARCH

Serum Lipids prior to Starting Androgen Deprivation Therapy and Risk of Castration Resistant Prostate Cancer and Metastasis: Results from the SEARCH Database

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