Cargando…

Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes

Objective To compare the survival outcomes of patients treated with surgery or radiotherapy for prostate cancer. Design Observational study. Setting Sweden, 1996-2010. Participants 34 515 men primarily treated for prostate cancer with surgery (n=21 533) or radiotherapy (n=12 982). Patients were cate...

Descripción completa

Detalles Bibliográficos
Autores principales: Sooriakumaran, Prasanna, Nyberg, Tommy, Akre, Olof, Haendler, Leif, Heus, Inge, Olsson, Mats, Carlsson, Stefan, Roobol, Monique J, Steineck, Gunnar, Wiklund, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3936107/
https://www.ncbi.nlm.nih.gov/pubmed/24574496
http://dx.doi.org/10.1136/bmj.g1502
_version_ 1782305269407023104
author Sooriakumaran, Prasanna
Nyberg, Tommy
Akre, Olof
Haendler, Leif
Heus, Inge
Olsson, Mats
Carlsson, Stefan
Roobol, Monique J
Steineck, Gunnar
Wiklund, Peter
author_facet Sooriakumaran, Prasanna
Nyberg, Tommy
Akre, Olof
Haendler, Leif
Heus, Inge
Olsson, Mats
Carlsson, Stefan
Roobol, Monique J
Steineck, Gunnar
Wiklund, Peter
author_sort Sooriakumaran, Prasanna
collection PubMed
description Objective To compare the survival outcomes of patients treated with surgery or radiotherapy for prostate cancer. Design Observational study. Setting Sweden, 1996-2010. Participants 34 515 men primarily treated for prostate cancer with surgery (n=21 533) or radiotherapy (n=12 982). Patients were categorised by risk group (low, intermediate, high, and metastatic), age, and Charlson comorbidity score. Main outcome measures Cumulative incidence of mortality from prostate cancer and other causes. Competing risks regression hazard ratios for radiotherapy versus surgery were computed without adjustment and after propensity score and traditional (multivariable) adjustments, as well as after propensity score matching. Several sensitivity analyses were performed. Results Prostate cancer mortality became a larger proportion of overall mortality as risk group increased for both the surgery and the radiotherapy cohorts. Among patients with non-metastatic prostate cancer the adjusted subdistribution hazard ratio for prostate cancer mortality favoured surgery (1.76, 95% confidence interval 1.49 to 2.08, for radiotherapy v prostatectomy), whereas there was no discernible difference in treatment effect among men with metastatic disease. Subgroup analyses indicated more clear benefits of surgery among younger and fitter men with intermediate and high risk disease. Sensitivity analyses confirmed the main findings. Conclusions This large observational study with follow-up to 15 years suggests that for most men with non-metastatic prostate cancer, surgery leads to better survival than does radiotherapy. Younger men and those with less comorbidity who have intermediate or high risk localised prostate cancer might have a greater benefit from surgery.
format Online
Article
Text
id pubmed-3936107
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher BMJ Publishing Group Ltd.
record_format MEDLINE/PubMed
spelling pubmed-39361072014-02-27 Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes Sooriakumaran, Prasanna Nyberg, Tommy Akre, Olof Haendler, Leif Heus, Inge Olsson, Mats Carlsson, Stefan Roobol, Monique J Steineck, Gunnar Wiklund, Peter BMJ Research Objective To compare the survival outcomes of patients treated with surgery or radiotherapy for prostate cancer. Design Observational study. Setting Sweden, 1996-2010. Participants 34 515 men primarily treated for prostate cancer with surgery (n=21 533) or radiotherapy (n=12 982). Patients were categorised by risk group (low, intermediate, high, and metastatic), age, and Charlson comorbidity score. Main outcome measures Cumulative incidence of mortality from prostate cancer and other causes. Competing risks regression hazard ratios for radiotherapy versus surgery were computed without adjustment and after propensity score and traditional (multivariable) adjustments, as well as after propensity score matching. Several sensitivity analyses were performed. Results Prostate cancer mortality became a larger proportion of overall mortality as risk group increased for both the surgery and the radiotherapy cohorts. Among patients with non-metastatic prostate cancer the adjusted subdistribution hazard ratio for prostate cancer mortality favoured surgery (1.76, 95% confidence interval 1.49 to 2.08, for radiotherapy v prostatectomy), whereas there was no discernible difference in treatment effect among men with metastatic disease. Subgroup analyses indicated more clear benefits of surgery among younger and fitter men with intermediate and high risk disease. Sensitivity analyses confirmed the main findings. Conclusions This large observational study with follow-up to 15 years suggests that for most men with non-metastatic prostate cancer, surgery leads to better survival than does radiotherapy. Younger men and those with less comorbidity who have intermediate or high risk localised prostate cancer might have a greater benefit from surgery. BMJ Publishing Group Ltd. 2014-02-27 /pmc/articles/PMC3936107/ /pubmed/24574496 http://dx.doi.org/10.1136/bmj.g1502 Text en © Sooriakumaran et al 2014 http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.
spellingShingle Research
Sooriakumaran, Prasanna
Nyberg, Tommy
Akre, Olof
Haendler, Leif
Heus, Inge
Olsson, Mats
Carlsson, Stefan
Roobol, Monique J
Steineck, Gunnar
Wiklund, Peter
Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes
title Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes
title_full Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes
title_fullStr Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes
title_full_unstemmed Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes
title_short Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes
title_sort comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3936107/
https://www.ncbi.nlm.nih.gov/pubmed/24574496
http://dx.doi.org/10.1136/bmj.g1502
work_keys_str_mv AT sooriakumaranprasanna comparativeeffectivenessofradicalprostatectomyandradiotherapyinprostatecancerobservationalstudyofmortalityoutcomes
AT nybergtommy comparativeeffectivenessofradicalprostatectomyandradiotherapyinprostatecancerobservationalstudyofmortalityoutcomes
AT akreolof comparativeeffectivenessofradicalprostatectomyandradiotherapyinprostatecancerobservationalstudyofmortalityoutcomes
AT haendlerleif comparativeeffectivenessofradicalprostatectomyandradiotherapyinprostatecancerobservationalstudyofmortalityoutcomes
AT heusinge comparativeeffectivenessofradicalprostatectomyandradiotherapyinprostatecancerobservationalstudyofmortalityoutcomes
AT olssonmats comparativeeffectivenessofradicalprostatectomyandradiotherapyinprostatecancerobservationalstudyofmortalityoutcomes
AT carlssonstefan comparativeeffectivenessofradicalprostatectomyandradiotherapyinprostatecancerobservationalstudyofmortalityoutcomes
AT roobolmoniquej comparativeeffectivenessofradicalprostatectomyandradiotherapyinprostatecancerobservationalstudyofmortalityoutcomes
AT steineckgunnar comparativeeffectivenessofradicalprostatectomyandradiotherapyinprostatecancerobservationalstudyofmortalityoutcomes
AT wiklundpeter comparativeeffectivenessofradicalprostatectomyandradiotherapyinprostatecancerobservationalstudyofmortalityoutcomes