Competing mortality contributes to excess mortality in patients with poor-risk lymph node-positive prostate cancer treated with radical prostatectomy.
BACKGROUND
Factors predicting survival in men with lymph node-positive prostate cancer are still poorly defined.


METHODS
193 prostate cancer patients with histopathologically proven lymph node involvement with a median follow-up of 7.3 years were studied. 94% of patients received immediate hormonal therapy. Kaplan-Meier curves were calculated to evaluate overall survival rates and compared with the log-rank test. Cumulative disease-specific and competing mortality rates were calculated by competing risk analysis and compared with the Pepe-Mori test. Cox proportional hazard models were used to determine the independent significance of predictors of all-cause mortality.


RESULTS
Age (70 years or older vs. younger), Gleason score (8-10 vs. 7 or lower) and the number of involved nodes (3 or more vs. 1-2) were identified as independent predictors of all-cause mortality. When patients with 0-1 of these risk factors were compared with those with 2-3 risk factors, all-cause (rates after 10 years 21% vs. 71%, p < 0.0001), disease-specific (12 vs. 37%, p = 0.009) and competing mortality (9 vs. 33%, p = 0.02) differed significantly.


CONCLUSIONS
Some of the excess mortality in patients with poor-risk lymph node-positive prostate cancer may be attributed to increased competing mortality, possibly caused by an interaction between comorbid diseases and hormonally treated persistent or progressive prostate cancer.
Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany. Michael.Froehner @ uniklinikum-dresden.de
Michael
M
Froehner
Albrecht
A
Scholz
Rainer
R
Koch
Oliver W
OW
Hakenberg
Gustavo B
GB
Baretton
Manfred P
MP
Wirth
D000368:Aged; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D012306:Risk; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome