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DaskivichAnnalsManuscript-1

DaskivichAnnalsManuscript-1

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Prostate Cancer Study
Prostate Cancer Study

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Published by: scprweb on May 20, 2013
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1
Impact of Age, Tumor Risk, and Comorbidity on Competing Risks for Survival in a U.S.
1
Population-Based Cohort of Men with Prostate Cancer 
2Running Title: Age, Comorbidity, and Tumor Risk in CaP34Timothy J. Daskivich, MD
1
 5Kang-Hsien Fan, MS
2
6Tatsuki Koyama, PhD
2
7Peter C. Albertsen, MD
3
8Michael Goodman, MD, MPH
4
9 Ann S. Hamilton, PhD
5
10Richard M. Hoffman, MD, MPH
6
11Janet L. Stanford, PhD, MPH
7
12 Antoinette M. Stroup, PhD
8
13Mark S. Litwin, MD, MPH
1
14David F. Penson, MD, MPH
9,10
1516
1
Department of Urology, David Geffen School of Medicine, University of California, Los Angeles,17Los Angeles, CA18
2
Department of Biostatistics, Vanderbilt University, Nashville, TN19
3
Department of Urology, University of Connecticut, Farmington, CT20
4
Department of Epidemiology, Emory University, Atlanta, GA21
5
Department of Preventative Medicine, Keck School of Medicine, University of Southern22California, Los Angeles, CA23
6
Department of Internal Medicine, University of New Mexico, Albuquerque, NM24
7
Department of Urology, Fred Hutchinson Cancer Center, Seattle, WA25
8
Department of Internal Medicine, University of Utah, Salt Lake City, UT26
9
Department of Urology, Vanderbilt University, Nashville, TN27
10
VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), Nashville,28TN293031Corresponding author:32David F. Penson, MD, MPH33Professor of Urologic Surgery34Director, Center for Surgical Quality and Outcomes Research35Vanderbilt University Medical Center 362525 West End Avenue, Suite 60037Nashville, TN 37203-173838(615) 343-152939
 
2fax (615) 936-829112david.penson @vanderbilt.edu34Word Count: 3604 Abstract: 299 Number of Tables: 2 Number of Figures: 356
 
3
ABSTRACT
Background: Accurate estimation of life expectancy is essential to offering appropriatecare to men with early-stage prostate cancer, but mortality risks associated withcomorbidity remain poorly defined.Objective: To determine the impact of age, comorbidity, and tumor risk on other-causeand prostate cancer-specific mortality in men with early-stage diseaseDesign: Prospective cohort studyPatients: 3,183 men with non-metastatic prostate cancer at diagnosisSetting: A nationally representative, population-based cohortMeasurements and analyses: Baseline self-reported comorbidity scored as a count of twelve major comorbid conditions, tumor characteristics, initial treatment, and overalland disease-specific mortality through 14-year follow up. Survival analyses accountingfor competing risks.Results: Fourteen-year cumulative other-cause mortality was 24%, 33%, 46%, and 57%,for men with comorbidity counts of 0, 1, 2, and 3+, respectively. For men diagnosed atage 65, subhazard ratios (95%CI) for other-cause mortality among men with 1, 2, or 3+comorbidities (vs. none) were 1.2 (1.0–1.5), 2.0 (1.6–2.4), and 2.6 (2.1–3.2), respectively.With each decade increase in age, the subhazard of other-cause mortality associatedwith each comorbidity count doubled; in men with 3+ comorbidities, subhazard ratios(95%CI) for ages 65 and 75 (vs. 55) were 2.0 (1.6–2.5) and 4.0 (2.7–6.1). In men with3+ comorbidities, ten-year other-cause mortality rates were 26%, 40%, and 71% for those aged
60, 61–74, and
75 at diagnosis, respectively. Prostate cancer mortalitywas minimal in low-(3%) and intermediate-risk(7%) disease but appreciable in high-risk

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