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Comparative effectiveness of aggressive versus nonaggressive treatment among men with early‐stage prostate cancer and differing comorbid disease burdens at diagnosis
Author(s) -
Daskivich Timothy J.,
Lai Julie,
Dick Andrew W.,
Setodji Claude M.,
Hanley Janet M.,
Litwin Mark S.,
Saigal Christopher
Publication year - 2014
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.28757
Subject(s) - medicine , confidence interval , prostate cancer , cancer , stage (stratigraphy) , comorbidity , relative risk , paleontology , biology
BACKGROUND This study sought to compare the effectiveness of aggressive versus nonaggressive treatment in reducing cancer‐specific mortality for older men with early‐stage prostate cancer across differing comorbid disease burdens at diagnosis. METHODS In total, the authors sampled 140,553 men aged ≥66 years with early‐stage prostate cancer who were diagnosed between 1991 and 2007 from the Surveillance, Epidemiology, and End Results‐Medicare database. Propensity‐adjusted competing‐risks regression analysis was used to compare the risk of cancer‐specific mortality between men who received aggressive versus nonaggressive treatment among comorbidity subgroups. RESULTS In propensity‐adjusted competing‐risks regression analysis, aggressive treatment was associated with a significantly lower risk of cancer‐specific mortality among men who had Charlson scores of 0, 1, and 2 but not among men who had Charlson scores ≥3 (subhazard ratio, 0.85; 95% confidence interval, 0.62‐1.18). The absolute reduction in 15‐year cancer‐specific mortality between men who received aggressive versus nonaggressive treatment was 6.1%, 4.3%, 3.9%, and 0.9% for men with Charlson scores of 0, 1, 2, and ≥3, respectively. Among men who had well‐differentiated and moderately‐differentiated tumors, aggressive treatment again was associated with a lower risk of cancer‐specific mortality for those who had Charlson scores of 0, 1, and 2 but not for those who had Charlson scores ≥3 (subhazard ratio, 1.14; 95% confidence interval, 0.70‐1.89). The absolute reduction in 15‐year cancer‐specific mortality between men who received aggressive versus nonaggressive treatment was 3.8%, 3%, 1.9%, and −0.5% for men with Charlson scores of 0, 1, 2, and ≥3, respectively. CONCLUSIONS The cancer‐specific survival benefit from aggressive treatment for early‐stage prostate cancer diminishes with increasing comorbidity at diagnosis. Men with Charlson scores ≥3 garner no survival benefit from aggressive treatment. Cancer 2014;120:2432–2439. © 2014 American Cancer Society .