Contemporary analysis of the effect of marital status on survival of prostate cancer patients across all stages: A population-based study

Knipper, Sophie; Preißer, Felix; Mazzone, Elio; Mistretta, Francesco A.; Palumbo, Carlotta; Tian, Zhe; Briganti, Alberto; Shariat, Shahrokh F.; Saad, Fred; Tilki, Derya; Graefen, Markus; Karakiewicz, Pierre I.

doi:10.1016/j.urolonc.2019.04.023

Cited by 12 publications

(9 citation statements)

References 19 publications

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“…Another unusual finding was that the unmarried and separated/divorced/widowed marital statuses were associated with a higher OCM risk. Other studies on PCa 6,25 and nonurological tumors 26,27 have produced findings consistent with this. This may be due to marital status affecting physical and mental health, with the latter being related to confidence and compliance with clinical treatment, 28,29 which is a vital part of prostate cancer prognoses 30 .…”

Section: Discussionsupporting

confidence: 81%

How socioeconomic and clinical factors impact prostate‐cancer‐specific and other‐cause mortality in prostate cancer stratified by clinical stage: Competing‐risk analysis

Han

et al. 2021

The Prostate

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Background The aim of this study was to analyze the causes of death and risk factors of prostate‐cancer‐specific mortality (PCSM) and other‐cause mortality (OCM) at different clinical stages using data from the Surveillance, Epidemiology, and End Results database. Methods The characteristics and cause‐specific death classifications of males with prostate cancer (PCa) were extracted. Multivariate competing‐risk regression analysis was used to identify significant predictors and quantify the cumulative incidence of PCSM and OCM at different clinical stages. Results Of the 244,433 PCa patients who were included, 19,274 died from 7356 PCSM, and 11,918 from OCM. The proportion of PCSM gradually increased from 2010 to 2016. The risk factors for PCSM in the localized PCa stage included older age, not being married, living in a county with higher poverty rates, and higher PSA levels and Gleason scores. Meanwhile, Medicaid and lower education levels were the additional risk factors of OCM. The risk factors for PCSM in the regional PCa stage included older age, not being married, Medicaid, living in a county with higher poverty rates, and higher PSA levels and Gleason scores. Meanwhile, the income level did not affect OCM risk. The risk factors for PCSM in the distant metastatic PCa stage included a separated/divorced/widowed marital status, Medicaid, and higher PSA levels and Gleason scores. Meanwhile, older age, an unmarried or separated/divorced/widowed marital status, and higher PSA levels were risk factors for OCM. In addition, receiving both surgery and radiation was worse than just receiving surgery for PCa specific survival in localized and regional PCa patients. Conclusion Some pretreatment and treatment factors may influence OCM that are not identical to those for PCSM at the corresponding stage. Decision‐makers and managers should fully consider OCM to maximize treatment benefits for PCa.

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Section: Discussionsupporting

confidence: 81%

How socioeconomic and clinical factors impact prostate‐cancer‐specific and other‐cause mortality in prostate cancer stratified by clinical stage: Competing‐risk analysis

Han

et al. 2021

The Prostate

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“…Our nomogram shows marriage as a protective factor, consistent with previous studies [28]. Cancer patients receive more nancial support and psychological comfort through marriage, and married patients seek treatment more actively out of responsibility to their families [29,30]. Race is also an independent risk factor for CSS and OS in patients with localized PC.…”

Section: Discussionsupporting

confidence: 89%

Prognostic significance of surgery and radiotherapy in elderly patients with localized prostate cancer:A SEER-based study

Zhanghuang

Zhang

Wang

et al. 2022

Preprint

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Objective Prostate cancer (PC) is a significant disease affecting men's health worldwide. More than 60% of patients over 65 years old and more than 80% are diagnosed with localized PC. The current choice of treatment modalities for localized PC and whether overtreatment is controversial. Therefore, we wanted to construct a nomogram to predict the risk factors associated with cancer-specific survival (CSS) and overall survival (OS) in elderly patients with localized PC while assessing the survival differences in surgery and radiotherapy for elderly patients with localized PC. Methods The information of patient was obtained from the Surveillance, Epidemiology, and End Results (SEER) database, and this study was aimed at localized PC patients over 65 years. Independent risk factors for assessing CSS and OS of patients were determined by univariate and multivariate Cox regression models. A multivariate Cox regression model was used to establish nomograms for predicting CSS and OS. The accuracy and discriminability of the prediction model were tested by the concordance index (C-index), the area under the receiver operating characteristic curve (AUC) and the calibration curve. Decision curve analysis (DCA) was used to test the potential clinical value of this model. Results From 2010 to 2018, there were a total of 90,434 PC patients included in this study, all of whom were diagnosed with localized PC and were over 65 years of age. This study is divided into training set (n = 63328) and validation set (n = 27106) according to the ratio of 7:3. The results showed that independent risk factors for predicting CSS in elderly localized PC patients included T stage, age, surgery, marriage, radiotherapy, prostate-specific antigen (PSA), Gleason score (GS), and race. The independent risk factors for predicting OS included surgery, radiotherapy, marriage, age, race, GS and PSA. The c-index of the training and validation sets for predicting OS is 0.712(95%:0.704–0.720) and 0.724(95%:0.714–0.734). It shows that the nomograms have excellent discriminatory ability. The AUC and the calibration curves also show good accuracy and discriminability. Conclusions We have developed new nomograms to predict CSS and OS in elderly patients with localized PC. After internal validation and external temporal validation with good accuracy and reliability, and potential clinical value, the model can be used for clinically assisted decision-making.

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“…This could support LT being considered in all PSA values, although a lower PSA value indicates a worse prognosis. Third, while some recent studies (17)(18)(19)(20) have reported marital status to be an independent prognostic factor for PCa, our study showed no statistical difference between different marital statuses. This discrepancy may be related to the insufficient sample size after PSM, as other studies have shown that marital quality ( 21) is also an important indicator of physical health.…”

Section: Discussioncontrasting

confidence: 87%

Effect on survival of local treatment in patients with low prostate-specific antigen, high Gleason score prostate cancer: a population-based propensity score-matched analysis

et al. 2020

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Background: Emerging data suggest that in patients with low prostate-specific antigen (PSA) and high Gleason score, prostate cancer (PCa) is more aggressive and more likely to be related to genomic characteristics of neuroendocrinology. However, the evidence for the advantages of local treatment (LT) for these men is lacking. Hence, we investigated survival in men with low-PSA values and high-grade (Gleason score 8-10) PCa according to the treatment of the primary tumor. Methods: Kaplan-Meier survival analysis was applied to analyze the effects on overall survival (OS) and cancer-specific survival (CSS) according to the different treatments of the primary tumor. Multivariable Cox proportional hazards survival regression analysis calculated the CSS after propensity score matching (PSM) in 2 cohorts according to treatment type. The treatment types included the following: (I) LT versus non-LT (NLT) and (II) radical prostatectomy (RP) versus radiotherapy (RT).Results: In the Surveillance, Epidemiology, and End Results (SEER) database [2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014], we identified 14,208 patients newly diagnosed with low PSA values (10 ng/mL or less), with a Gleason score 8-10, and cT1-4N0M0 prostate adenocarcinoma. After the first PSM, of the 3,512 PCa patients, 1,576 underwent LT and 1,576 underwent NLT. After the second PSM, of the 792 PCa patients, 396 underwent RP, and 396 underwent RT. The 5-and 10-year OS rates for LT vs. NLT patients were 90% and 73% versus 69% and 39%, respectively, while the 5-and 10-year CSS rates for LT vs. NLT patients were 98% and 94% versus 89% and 79%, respectively. Subsequent multivariate survival analysis showed that LT was associated with lower likelihood of PCa mortality relative to NLT [hazard ratio (HR), 0.19; 95% confidence interval (CI), 0.14-0.26, P<0.001], also in RP versus RT (HR, 0.26; 95% CI, 0.12-0.54, P<0.001). Conclusions:In patients with low PSA values, Gleason score 8-10, and localized PCa, LT resulted in higher survival compared with NLT. Within LT, RP provided the most benefit relative to RT.

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Contemporary analysis of the effect of marital status on survival of prostate cancer patients across all stages: A population-based study

Cited by 12 publications

References 19 publications

How socioeconomic and clinical factors impact prostate‐cancer‐specific and other‐cause mortality in prostate cancer stratified by clinical stage: Competing‐risk analysis

How socioeconomic and clinical factors impact prostate‐cancer‐specific and other‐cause mortality in prostate cancer stratified by clinical stage: Competing‐risk analysis

Prognostic significance of surgery and radiotherapy in elderly patients with localized prostate cancer:A SEER-based study

Effect on survival of local treatment in patients with low prostate-specific antigen, high Gleason score prostate cancer: a population-based propensity score-matched analysis

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