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Competing risks of mortality in prostate cancer
A Krongrad1, H Lai, S Lai
1Department of Urology, University of Miami School of Medicine, Florida, USA.
The Journal of Urology
|September 1, 1997
Summary
Prostate cancer mortality is influenced by age, race, and treatment. These factors impact both disease-specific and nonspecific mortality, suggesting underlying health factors affecting overall survival.
Area of Science:
- Oncology
- Epidemiology
- Biostatistics
Background:
- Prognostic factors in prostate cancer, including age, race, disease stage, and treatment, are known to influence mortality.
- Previous studies often examined disease-specific and overall mortality separately, limiting a comprehensive understanding of contributing factors.
- The interplay between disease-specific and nonspecific mortality in relation to these prognostic variables requires further investigation.
Purpose of the Study:
- To jointly evaluate the effects of prognostic factors on both the type and time to death in prostate cancer patients.
- To understand how factors like age, race, stage, and treatment influence disease-specific versus nonspecific mortality.
- To clarify the relationship between prognostic variables and overall mortality by dissecting its components.
Main Methods:
- Utilized data from the Surveillance, Epidemiology, and End Results (SEER) program (1973-1990).
- Employed competing risks analysis with a multivariate accelerated failure time model.
- Examined the association of prognostic factors with distinct types of mortality and time to death.
Main Results:
- Older age, black race, and lack of treatment were independently linked to increased relative risks for both disease-specific and nonspecific mortality.
- Localized stage showed varied associations, being linked to lower disease-specific mortality but higher nonspecific mortality compared to regional stage.
- Significant differences were observed in the relative risks of disease-specific and nonspecific mortality across all evaluated prognostic factors.
Conclusions:
- This study presents the first competing risks analysis for prostate cancer mortality.
- Prognostic factors influence both disease-specific and nonspecific mortality, but their relative contributions to overall mortality vary.
- The consistent association of age, race, and treatment with both mortality types suggests an underlying, unidentified factor impacting general health, potentially explaining treatment effects on disease-specific mortality.