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Interaction of adjuvant androgen deprivation therapy with patient comorbidity status on overall survival after radical prostatectomy for high‐risk prostate cancer
Author(s) -
Linder Brian J,
Boorjian Stephen A,
Umbreit Eric C,
Carlson Rachel E,
Rangel Laureano J,
Bergstralh Eric J,
Karnes R Jeffrey
Publication year - 2013
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12047
Subject(s) - medicine , prostatectomy , hormonal therapy , comorbidity , androgen deprivation therapy , prostate cancer , adjuvant therapy , hormone therapy , adjuvant , cancer , proportional hazards model , oncology , urology , breast cancer
Background To evaluate the impact of adjuvant hormonal therapy after radical prostatectomy on overall survival in high‐risk prostate cancer patients, stratified by comorbidity status. Methods We identified 1247 patients who underwent radical prostatectomy from 1988 to 2004 for high‐risk prostate cancer, as defined by N ational C omprehensive C ancer N etwork classification. Comorbidity status was stratified by C harlson C omorbidity I ndex as 0, 1 or >2, as well as by the presence or absence of cardiovascular disease. Overall survival was estimated by the K aplan– M eier method, and compared within each comorbidity category/adjuvant hormonal therapy strata with the log–rank test. Results Median patient age was 65 years, and the median postoperative follow up was 11.2 years. In total, 419 patients (34%) received adjuvant hormonal therapy. The distribution of C harlson C omorbidity I ndex was 0, 1 and ≥2 in 861 (69%), 244 (20%) and 142 (11%) patients, respectively. The 10‐year overall survival for patients who received adjuvant hormonal therapy versus those who did not was 75% versus 82% ( P = 0.54) for patients with C harlson C omorbidity I ndex = 0, 72% versus 76% ( P = 0.83) with C harlson C omorbidity I ndex = 1, and 70% versus 68% ( P = 0.33) with C harlson C omorbidity I ndex ≥2. Meanwhile, 155 (12%) patients had cardiovascular disease, and the 10‐year overall survival for patients with cardiovascular disease who received adjuvant hormonal therapy was 72%, compared with 76% without adjuvant hormonal therapy ( P = 0.97). On multivariate analysis, receipt of adjuvant hormonal therapy was not associated with non‐prostate cancer mortality ( P = 0.24). Conclusions Adjuvant hormonal therapy after radical prostatectomy for high‐risk prostate cancer does not increase non‐prostate cancer mortality, even among patients with multiple comorbidities. Additional studies are warranted to determine optimal multimodal treatment approach for high‐risk patients.