Does increasing life expectancy affect competing mortality after radical prostatectomy?

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• 作者：Michael Froehner ; M.D.^a ; ^{Michael.Froehner@uniklinikum-dresden.de" class="auth_mail} ; Rainer Koch ; Ph.D.^b ; Manfred P. Wirth ; M.D.^a ; Meike Adam ; M.D.^c ; Thorsten Schlomm ; M.D.^c ; Hartwig Huland ; M.D.^c ; Markus Graefen ; M.D.^c
• 关键词：Prostate cancer ; Radical prostatectomy ; Life expectancy ; Competing mortality ; Survival ; Active surveillance
• 刊名：Urologic Oncology: Seminars and Original Investigations
• 出版年：May 2014
• 年：2014
• 卷：32
• 期：4
• 页码：413-418
• 全文大小：293 K

文摘

In Germany, between 1991 to 1993 and 2004 to 2006, the life expectancy in men increased by 4.2 years with greater gains in the eastern part of the country. In this study, we investigated to which degree this life-expectancy increase was translated into lower competing mortality rates after radical prostatectomy.

Methods and materials

The study sample comprised 6,831 consecutive patients who underwent radical prostatectomy at the Department of Urology of the Dresden University of Technology and the Department of Urology of the University of Hamburg/Martini Clinic in the years 1992 to 2005. The median age was 63.0 years and the median follow-up was 8.6 years. Three time periods (1992–1995, 1996–2001, and 2002–2005) were compared. Competing mortality was the study end point. Rates after 8 years were used for comparison. Comparisons of mortality rates were made with the 2-sided Wald test.

Results

The 8-year competing mortality rates decreased from 7.6% (1992–1995) via 5.6% (1996–2001) to 4.7% (2002–2005 vs. 1992–1995; P = 0.0127). When deaths due to unknown causes (92 of 969 deaths) were considered as non–prostate cancer competing deaths, the corresponding figures were 9.0 % (1992–1995), 6.5% (1996–2001), and 5.6% (2002–2005) vs. 1992 to 1995; P = 0.0107. The effect was greater in men who are 65 years of age or older and those of East German origin.

Conclusions

Parallel to the increasing life expectancy in Germany, the competing mortality after radical prostatectomy decreased in both centers mainly in men who are 65 years of age or older. This information may be important for elderly men considering alternatives to immediate curative treatment for early prostate cancer.