Influencing factors for mortality in prostate cancer patients with T1 and T2 stage: a retrospective cohort study

Xuwei Hong; Sizhe Cao; Zepai Chi; Yuanfeng Zhang; Tianxin Lin; Yonghai Zhang

doi:10.21037/tau-22-818

Influencing factors for mortality in prostate cancer patients with T1 and T2 stage: a retrospective cohort study

Transl Androl Urol. 2023 Jan 30;12(1):58-70. doi: 10.21037/tau-22-818. Epub 2023 Jan 12.

Authors

Xuwei Hong^#^{1

2}, Sizhe Cao^#^{2

3}, Zepai Chi², Yuanfeng Zhang², Tianxin Lin¹, Yonghai Zhang²

Affiliations

¹ Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
² Department of Urology, Shantou Central Hospital, Shantou, China.
³ College of Medicine, Shantou University, Shantou, China.

^# Contributed equally.

Abstract

Background: Few reports have focused on the influencing factors of localized prostate cancer (PCa)-specific mortality so far. This study aimed to develop a competitive risk model for identifying the factors influencing the localized PCa mortality rate based on 135,310 subjects in the Surveillance, Epidemiology, and End Results (SEER) database.

Methods: We included 135,310 localized PCa male patients from SEER database 2004-2016 in this cohort study, and collected the baseline information of all patients, including age of diagnosis, race, marital status, socioeconomic status (SES), American Joint Committee on Cancer (AJCC) stage, prostate-specific antigen (PSA) Gleason score, and so on. The outcome was considered as PCa-specific mortality in this study. The end time of follow-up was November 2018. Independent risk factors were examined by multivariate Fine-Gray analysis. The results are shown by hazard ratio (HR) and 95% confidence interval (CI).

Results: All patients were divided into three groups: died from localized PCa (n=1,400), died from other causes (n=16,996), and survived (n=116,914). The diagnostic age of 119,899 patients was ≥55 years. The multivariate Fine-Gray analysis indicated that age of diagnosis (55-70 years: HR =1.473, 95% CI: 1.124-1.930; >70 years: HR =2.528, 95% CI: 1.901-3.362), race (American India/Alaska Native, Asian/Pacific Islander: HR =0.653, 95% CI: 0.490-0.870), marital status (divorced: HR =1.433, 95% CI: 1.197-1.717; single: HR =1.463, 95% CI: 1.244-1.719; widowed: HR =1.485, 95% CI: 1.222-1.804), therapeutic method (radiotherapy: HR =1.500; 95% CI: 1.119-2.011), SES (4-10: HR =0.799, 95% CI: 0.664-0.961; ≥11: HR =0.670; 95% CI: 0.534-0.839), AJCC stage (HR =0.820, 95% CI: 0.715-0.940), level of PSA (HR: 1.002, 95% CI: 1.002-1.002) and Gleason score (HR: 2.226, 95% CI: 2.108-2.350) were associated with the risk of localized PCa mortality.

Conclusions: The study determined the influencing factors for mortality in patients with localized PCa through a competitive risk model. This finding may provide a reference for localized PCa patients: localized PCa patients who are older, divorced, widowed, single, have a radiotherapy, have a high PSA level, and Gleason score may be at high risk.

Keywords: Fine-Gray model; Localized prostate cancer (PCa); influencing factors; mortality.