Discerning the survival advantage among patients with prostate cancer who undergo radical prostatectomy or radiotherapy

The limitations of cancer registry data

Stephen Williams, Jinhai Huo, Karim Chamie, Marc C. Smaldone, Christopher D. Kosarek, Justin E. Fang, Leslie M. Ynalvez, Simon P. Kim, Karen E. Hoffman, Sharon H. Giordano, Brian F. Chapin

    Research output: Contribution to journalArticle

    15 Citations (Scopus)

    Abstract

    BACKGROUND: The objective of this study was to compare the overall survival of patients who undergo radical prostatectomy or radiotherapy versus noncancer controls to discern whether there is a survival advantage according to prostate cancer treatment and the impact of selection bias on these results. METHODS: A matched cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. In total, 34,473 patients ages 66 to 75 years were identified who were without significant comorbidity, were diagnosed with localized prostate cancer, and received treatment treated with surgery or radiotherapy between 2004 and 2011. These patients were matched to a noncancer control cohort. The rates of all-cause mortality that occurred within the study period were compared. Cox proportional hazards regression analysis was used to identify determinants associated with overall survival. RESULTS: Of 34,473 patients who were included in the analysis, 21,740 (63%) received radiation therapy, and 12,733 (37%) underwent surgery. There was improved survival in patients who underwent surgery (hazard ratio, 0.35; 95% confidence interval, 0.32-0.38) and in those who received radiotherapy (hazard ratio, 0.72; 95% confidence interval, 0.68-0.75) compared with noncancer controls. Overall survival improved significantly in both treatment groups, with the greatest benefit observed among patients who underwent surgery (log rank P<.001). CONCLUSIONS: Population-based data indicated that patients with prostate cancer who received treatment with either surgery or radiotherapy had improved overall survival compared with a cohort of matched noncancer controls. Surgery produce longer survival compared with radiation therapy. These results suggest an inherent selection-bias because of unmeasured confounding variables.

    Original languageEnglish (US)
    JournalCancer
    DOIs
    StateAccepted/In press - 2017

    Fingerprint

    Prostatectomy
    Registries
    Prostatic Neoplasms
    Radiotherapy
    Survival
    Neoplasms
    Selection Bias
    Confidence Intervals
    Confounding Factors (Epidemiology)
    Therapeutics
    Medicare
    Comorbidity
    Epidemiology
    Cohort Studies
    Regression Analysis
    Databases
    Mortality
    Population

    Keywords

    • Outcomes
    • Prostate cancer
    • Prostatectomy
    • Survival
    • Treatments
    • Utilization

    ASJC Scopus subject areas

    • Oncology
    • Cancer Research

    Cite this

    Discerning the survival advantage among patients with prostate cancer who undergo radical prostatectomy or radiotherapy : The limitations of cancer registry data. / Williams, Stephen; Huo, Jinhai; Chamie, Karim; Smaldone, Marc C.; Kosarek, Christopher D.; Fang, Justin E.; Ynalvez, Leslie M.; Kim, Simon P.; Hoffman, Karen E.; Giordano, Sharon H.; Chapin, Brian F.

    In: Cancer, 2017.

    Research output: Contribution to journalArticle

    Williams, Stephen ; Huo, Jinhai ; Chamie, Karim ; Smaldone, Marc C. ; Kosarek, Christopher D. ; Fang, Justin E. ; Ynalvez, Leslie M. ; Kim, Simon P. ; Hoffman, Karen E. ; Giordano, Sharon H. ; Chapin, Brian F. / Discerning the survival advantage among patients with prostate cancer who undergo radical prostatectomy or radiotherapy : The limitations of cancer registry data. In: Cancer. 2017.
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    abstract = "BACKGROUND: The objective of this study was to compare the overall survival of patients who undergo radical prostatectomy or radiotherapy versus noncancer controls to discern whether there is a survival advantage according to prostate cancer treatment and the impact of selection bias on these results. METHODS: A matched cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. In total, 34,473 patients ages 66 to 75 years were identified who were without significant comorbidity, were diagnosed with localized prostate cancer, and received treatment treated with surgery or radiotherapy between 2004 and 2011. These patients were matched to a noncancer control cohort. The rates of all-cause mortality that occurred within the study period were compared. Cox proportional hazards regression analysis was used to identify determinants associated with overall survival. RESULTS: Of 34,473 patients who were included in the analysis, 21,740 (63{\%}) received radiation therapy, and 12,733 (37{\%}) underwent surgery. There was improved survival in patients who underwent surgery (hazard ratio, 0.35; 95{\%} confidence interval, 0.32-0.38) and in those who received radiotherapy (hazard ratio, 0.72; 95{\%} confidence interval, 0.68-0.75) compared with noncancer controls. Overall survival improved significantly in both treatment groups, with the greatest benefit observed among patients who underwent surgery (log rank P<.001). CONCLUSIONS: Population-based data indicated that patients with prostate cancer who received treatment with either surgery or radiotherapy had improved overall survival compared with a cohort of matched noncancer controls. Surgery produce longer survival compared with radiation therapy. These results suggest an inherent selection-bias because of unmeasured confounding variables.",
    keywords = "Outcomes, Prostate cancer, Prostatectomy, Survival, Treatments, Utilization",
    author = "Stephen Williams and Jinhai Huo and Karim Chamie and Smaldone, {Marc C.} and Kosarek, {Christopher D.} and Fang, {Justin E.} and Ynalvez, {Leslie M.} and Kim, {Simon P.} and Hoffman, {Karen E.} and Giordano, {Sharon H.} and Chapin, {Brian F.}",
    year = "2017",
    doi = "10.1002/cncr.30506",
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    TY - JOUR

    T1 - Discerning the survival advantage among patients with prostate cancer who undergo radical prostatectomy or radiotherapy

    T2 - The limitations of cancer registry data

    AU - Williams, Stephen

    AU - Huo, Jinhai

    AU - Chamie, Karim

    AU - Smaldone, Marc C.

    AU - Kosarek, Christopher D.

    AU - Fang, Justin E.

    AU - Ynalvez, Leslie M.

    AU - Kim, Simon P.

    AU - Hoffman, Karen E.

    AU - Giordano, Sharon H.

    AU - Chapin, Brian F.

    PY - 2017

    Y1 - 2017

    N2 - BACKGROUND: The objective of this study was to compare the overall survival of patients who undergo radical prostatectomy or radiotherapy versus noncancer controls to discern whether there is a survival advantage according to prostate cancer treatment and the impact of selection bias on these results. METHODS: A matched cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. In total, 34,473 patients ages 66 to 75 years were identified who were without significant comorbidity, were diagnosed with localized prostate cancer, and received treatment treated with surgery or radiotherapy between 2004 and 2011. These patients were matched to a noncancer control cohort. The rates of all-cause mortality that occurred within the study period were compared. Cox proportional hazards regression analysis was used to identify determinants associated with overall survival. RESULTS: Of 34,473 patients who were included in the analysis, 21,740 (63%) received radiation therapy, and 12,733 (37%) underwent surgery. There was improved survival in patients who underwent surgery (hazard ratio, 0.35; 95% confidence interval, 0.32-0.38) and in those who received radiotherapy (hazard ratio, 0.72; 95% confidence interval, 0.68-0.75) compared with noncancer controls. Overall survival improved significantly in both treatment groups, with the greatest benefit observed among patients who underwent surgery (log rank P<.001). CONCLUSIONS: Population-based data indicated that patients with prostate cancer who received treatment with either surgery or radiotherapy had improved overall survival compared with a cohort of matched noncancer controls. Surgery produce longer survival compared with radiation therapy. These results suggest an inherent selection-bias because of unmeasured confounding variables.

    AB - BACKGROUND: The objective of this study was to compare the overall survival of patients who undergo radical prostatectomy or radiotherapy versus noncancer controls to discern whether there is a survival advantage according to prostate cancer treatment and the impact of selection bias on these results. METHODS: A matched cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. In total, 34,473 patients ages 66 to 75 years were identified who were without significant comorbidity, were diagnosed with localized prostate cancer, and received treatment treated with surgery or radiotherapy between 2004 and 2011. These patients were matched to a noncancer control cohort. The rates of all-cause mortality that occurred within the study period were compared. Cox proportional hazards regression analysis was used to identify determinants associated with overall survival. RESULTS: Of 34,473 patients who were included in the analysis, 21,740 (63%) received radiation therapy, and 12,733 (37%) underwent surgery. There was improved survival in patients who underwent surgery (hazard ratio, 0.35; 95% confidence interval, 0.32-0.38) and in those who received radiotherapy (hazard ratio, 0.72; 95% confidence interval, 0.68-0.75) compared with noncancer controls. Overall survival improved significantly in both treatment groups, with the greatest benefit observed among patients who underwent surgery (log rank P<.001). CONCLUSIONS: Population-based data indicated that patients with prostate cancer who received treatment with either surgery or radiotherapy had improved overall survival compared with a cohort of matched noncancer controls. Surgery produce longer survival compared with radiation therapy. These results suggest an inherent selection-bias because of unmeasured confounding variables.

    KW - Outcomes

    KW - Prostate cancer

    KW - Prostatectomy

    KW - Survival

    KW - Treatments

    KW - Utilization

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    U2 - 10.1002/cncr.30506

    DO - 10.1002/cncr.30506

    M3 - Article

    JO - Cancer

    JF - Cancer

    SN - 0008-543X

    ER -