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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

 Kyo Chul Koo  ;  Jin Seon Cho  ;  Woo Jin Bang  ;  Seung Hwan Lee  ;  Sung Yong Cho  ;  Sun Il Kim  ;  Se Joong Kim  ;  Koon Ho Rha  ;  Sung Joon Hong  ;  Byung Ha Chung 
 Cancer Research and Treatment, Vol.50(1) : 129-137, 2018 
Journal Title
 Cancer Research and Treatment 
Issue Date
Prostatectomy ; Prostatic neoplasms ; Radiotherapy ; Treatment outcome
PURPOSE: Studies 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 METHODS: The 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. RESULTS: Median 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). CONCLUSION: RP 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.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
구교철(Koo, Kyo Chul) ORCID logo https://orcid.org/0000-0001-7303-6256
나군호(Rha, Koon Ho) ORCID logo https://orcid.org/0000-0001-8588-7584
이승환(Lee, Seung Hwan) ORCID logo https://orcid.org/0000-0001-7358-8544
정병하(Chung, Byung Ha) ORCID logo https://orcid.org/0000-0001-9817-3660
홍성준(Hong, Sung Joon) ORCID logo https://orcid.org/0000-0001-9869-065X
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