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Survival and mortality of elderly men with localized prostate cancer managed with primary androgen deprivation therapy or by primary observation
BMC Urology ( IF 2 ) Pub Date : 2020-03-12 , DOI: 10.1186/s12894-020-00593-7
Heikki Seikkula 1 , Peter J Boström 2, 3 , Karri Seppä 4 , Janne Pitkäniemi 4, 5, 6 , Nea Malila 4, 7 , Antti Kaipia 8
Affiliation  

Androgen deprivation therapy (ADT) remains a primary treatment for localized prostate cancer (PCa) even though there is no evidence that its use is beneficial in the absence of curative treatment. Men aged ≥70 years (n = 16,534) diagnosed with localized PCa from 1985 to 2014 and managed either with primary observation or ADT in the absence of curative treatment were included. The cases were identified from the population-based Finnish Cancer Registry. We estimated the standardized mortality ratios (SMR) for overall mortality by treatment group. We determined the relative risk (RR) of PCa-specific mortality (PCSM) and other-cause mortality between the two treatment groups. Survival was determined using the life table method. Two age groups (70–79 years and ≥ 80 years) and three calendar time cohorts (1985–1994, 1995–2004, and 2005–2014) were compared following adjustment of propensity score matching between the treatment groups with four covariates (age, year of diagnosis, educational level, and hospital district). Follow-up continued until death or until December 31, 2015. Patients in the observation group had lower overall SMRs than those in the ADT group in both age cohorts over the entire study period. PCSM was higher in men aged 70–79 years undergoing primary ADT compared to those managed by observation only (RR: 1.70, 95% confidence interval [CI]: 1.29–2.23 [1985–1994]; RR 1.55, 95% CI: 1.35–1.84 [1995–2004]; and RR 2.71, 95% CI: 2.08–3.53 [2005–2014]); p = 0.005 for periodic trend. A similar trend over time was also observed in men aged > 80 years; (p for age–period interaction = 0.237). Overall survival was also higher among men in their 70’s managed by observation compared to those undergoing ADT. Primary ADT within four months period from diagnosis is not associated with improved long-term overall survival or decreased PCSM compared to primary conservative management for men with localized PCa. However, this observational study’s conclusions should be weighted with confounding factors related to cancer aggressiveness and comorbidities.

中文翻译:

接受初级雄激素剥夺疗法或初级观察治疗的局限性前列腺癌老年男性的生存率和死亡率

雄激素剥夺疗法 (ADT) 仍然是局部前列腺癌 (PCa) 的主要治疗方法,尽管没有证据表明在没有治愈性治疗的情况下使用它是有益的。包括 1985 年至 2014 年被诊断患有局限性 PCa 并在没有治愈性治疗的情况下通过初步观察或 ADT 进行治疗的年龄≥70 岁的男性 (n = 16,534)。这些病例是从基于人口的芬兰癌症登记处确定的。我们估计了治疗组总体死亡率的标准化死亡率 (SMR)。我们确定了两个治疗组之间 PCa 特异性死亡率 (PCSM) 和其他原因死亡率的相对风险 (RR)。使用生命表方法确定存活率。两个年龄组(70-79 岁和 80 岁以上)和三个日历时间组(1985-1994、1995-2004、和 2005-2014 年)在调整治疗组之间的倾向评分匹配后与四个协变量(年龄、诊断年份、教育水平和医院区)进行比较。随访持续至死亡或直至 2015 年 12 月 31 日。在整个研究期间,观察组患者的总体 SMR 低于两个年龄组的 ADT 组患者。与仅接受观察治疗的男性相比,接受初级 ADT 的 70-79 岁男性的 PCSM 更高(RR:1.70,95% 置信区间 [CI]:1.29-2.23 [1985-1994];RR 1.55,95% CI:1.35) –1.84 [1995–2004];和 RR 2.71,95% CI:2.08–3.53 [2005–2014]);对于周期性趋势,p = 0.005。随着时间的推移,在 80 岁以上的男性中也观察到了类似的趋势;(年龄-时期相互作用的 p = 0.237)。与接受 ADT 的人相比,通过观察管理的 70 多岁男性的总生存率也更高。与局部 PCa 男性的主要保守治疗相比,诊断后四个月内的主要 ADT 与改善长期总生存率或降低 PCSM 无关。然而,这项观察性研究的结论应该与与癌症侵袭性和合并症相关的混杂因素加权。
更新日期:2020-04-22
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