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Comorbidity, treatment and mortality : a population based cohort study of prostate cancer in PCBaSe Sweden

Berglund, Anders (författare)
Garmo, Hans (författare)
Tishelman, Carol (författare)
visa fler...
Holmberg, Lars (författare)
Stattin, Pär, (författare)
Umeå universitet, Urologi och andrologi
Lambe, Mats (författare)
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Umeå universitet Medicinska fakulteten. Institutionen för kirurgisk och perioperativ vetenskap. Urologi och andrologi. (creator_code:org_t)
Uppsala universitet Medicinska och farmaceutiska vetenskapsområdet. Medicinska fakulteten. Institutionen för kirurgiska vetenskaper. Endokrinkirurgi. (creator_code:org_t)
2011
Engelska.
Ingår i: Journal of Urology. - Elsevier. - 0022-5347. ; 185:3, s. 833-840
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • PurposeWe examined associations among comorbidity, treatment decisions and mortality in patients with prostate cancer.Materials and MethodsA total of 77,536 men diagnosed with prostate cancer between 1997 and 2006 were identified in PCBaSe Sweden from the National Prostate Cancer Register of Sweden. Logistic, Cox and competing risk regression were used to assess associations among Charlson comorbidity index, treatment and mortality. The Charlson comorbidity index was categorized into no (0), mild (1) and severe comorbidity (2+).ResultsIn men with low risk prostate cancer 5,975 of the 13,245 (45.1%) patients without comorbidity underwent radical prostatectomy compared to 256 of the 1,399 (18.9%) men with severe comorbidity. Following adjustment for age and period of diagnosis, radical prostatectomy was less likely to be offered to men with severe comorbidity (OR 0.48, 95% CI 0.41–0.55). In men with high risk prostate cancer, radiotherapy was more common (range 7.7% to 21.3%) than radical prostatectomy (range 3.0% to 11.2%) regardless of comorbidity burden. All cause and competing cause but not prostate cancer specific mortality were increased in men with severe comorbidity (all cause HR 1.99, 95% CI 1.93–2.05; competing cause sHR 2.66, 95% CI 2.56–2.78; prostate cancer specific sHR 0.98, 95% CI 0.93–1.03). The cumulative probability of prostate cancer death given no death from competing causes was significantly higher in men with severe comorbidity in all risk groups (p <0.01).ConclusionsComorbidity affects treatment choices, and is associated with all cause, competing cause and conditional prostate cancer specific mortality. An increased conditional prostate cancer specific mortality in men with severe comorbidity may reflect less aggressive treatment, impaired tumor defense, lifestyle factors and poor general health behavior.

Nyckelord

Medical and Health Sciences Clinical Medicine Cancer and Oncology
Medicin och hälsovetenskap Klinisk medicin Cancer och onkologi
Medical and Health Sciences Clinical Medicine Urology and Nephrology
Medicin och hälsovetenskap Klinisk medicin Urologi och njurmedicin
MEDICINE Surgery Oncology
MEDICIN Kirurgi Onkologi
MEDICINE Surgery Surgical research Urology and andrology
MEDICIN Kirurgi Kirurgisk forskning Urologi och andrologi
Oncology
onkologi
prostatic neoplasms
comorbidity
therapeutics
risk
mortality
Medical and Health Sciences Other Medical Sciences
Medicin och hälsovetenskap Annan medicin och hälsovetenskap

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