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A Competing Risk Analysis of Cancer-Specific Mortality of Initial Treatment with Radical Prostatectomy versus Radiation Therapy in Clinically Localized High-Risk Prostate Cancer

Authors
 Joo Yong Lee  ;  Kang Su Cho  ;  Jong Kyou Kwon  ;  Seong Uk Jeh  ;  Ho Won Kang  ;  Richilda Red Diaz  ;  Won Sik Ham  ;  Woong Sub Koom  ;  Ki Chang Keum  ;  Young Deuk Choi 
Citation
 Annals of Surgical Oncology, Vol.21(12) : 4026-4033, 2014 
Journal Title
 Annals of Surgical Oncology 
ISSN
 1068-9265 
Issue Date
2014
MeSH
Aged ; Combined Modality Therapy ; Follow-Up Studies ; Humans ; Male ; Neoplasm Grading ; Prognosis ; Propensity Score ; Prostatectomy* ; Prostatic Neoplasms/mortality* ; Prostatic Neoplasms/radiotherapy ; Prostatic Neoplasms/surgery ; Radiotherapy* ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Survival Rate
Keywords
Prostate Cancer ; Propensity Score ; Radical Prostatectomy ; National Comprehensive Cancer Network ; National Comprehensive Cancer Network
Abstract
BACKGROUND: There is no consensus on the optimal treatment for localized high-risk prostate cancer (PC), and much debate exists regarding the ideal treatment approach. For these reasons, we evaluated the competing risks of PC-specific mortality after initial therapy with radical prostatectomy (RP) versus radiotherapy (RT) in men with clinically localized high-risk PC. METHODS: We reviewed patients treated with RP and RT combined with androgen-deprivation therapy between 1990 and 2009. High-risk PC is defined as clinical stage ≥T3a, serum prostate-specific antigen (PSA) >20 ng/mL, or a biopsy Gleason sum of 8-10 according to National Comprehensive Cancer Network guidelines. Competing risk analysis was conducted to assess the association of RP (n = 251) or RT (n = 125) with cancer-specific mortality (CSM). Thereafter, secondary analysis with propensity score matching was conducted to further elucidate patient characteristics, with optimal matching of 0.25 times the standard deviation of propensity scores. RESULTS: With an overall median follow-up of 76 months, 35 (9.3 %) men with high-risk PC died due to PC (23 in the RT group and 12 in the RP group). The 5-year estimates of cancer-specific survival rate for men treated with RP and RT were 96.5 % (95 % confidence interval [CI] 94.2-98.9) and 88.3 % (95 % CI 82.8-94.3), respectively. Cumulative incidence estimates for CSM were statistically increased amongst men treated with RT (p = 0.002). Propensity score matching extracted 168 men with high-risk PC from the total patient cohort. Cumulative incidence estimates for CSM were statistically different amongst men treated with RT (p < 0.001).
Full Text
http://link.springer.com/article/10.1245%2Fs10434-014-3780-9
DOI
10.1245/s10434-014-3780-9
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
7. Others (기타) > Dept. of Health Promotion (건강의학과) > 1. Journal Papers
Yonsei Authors
Kang, Ho Won(강호원)
Kwon, Jong Kyou(권종규)
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Diaz, Richilda Red(리칠다)
Lee, Joo Yong(이주용) ORCID logo https://orcid.org/0000-0002-3470-1767
Jeh, Seong Uk(제성욱)
Cho, Kang Su(조강수) ORCID logo https://orcid.org/0000-0002-3500-8833
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99996
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