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07.02.2018 | Original Article – Cancer Research | Ausgabe 4/2018

Journal of Cancer Research and Clinical Oncology 4/2018

Impact of comorbidities at diagnosis on prostate cancer treatment and survival

Zeitschrift:
Journal of Cancer Research and Clinical Oncology > Ausgabe 4/2018
Autoren:
Katarina Luise Matthes, Manuela Limam, Giulia Pestoni, Leonhard Held, Dimitri Korol, Sabine Rohrmann
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00432-018-2596-6) contains supplementary material, which is available to authorized users.

Abstract

Background

The aim of this study was to assess the associations of comorbidities with primary treatment of prostate cancer (PCa) patients and of comorbidities with PCa-specific mortality (PCSM) compared to other-cause mortality (OCM) in Switzerland.

Patients and methods

We included 1527 men diagnosed with PCa in 2000 and 2001 in the canton of Zurich. Multiple imputation methods were applied to missing data for stage, grade and comorbidities. Multinomial logistic regression analyses were used to explore the associations of comorbidities with treatment. Cox regression models were used to estimate all-cause mortality, and Fine and Gray competing risk regression models to estimate sub-distribution hazard ratios for the outcomes PCSM and OCM.

Results

Increasing age was associated with a decreasing probability of receiving curative treatment, whereas an increasing Charlson Comorbidity Index (CCI) did not influence the treatment decision as strongly as age. The probability of OCM was higher for patients with comorbidities compared to those without comorbidities [CCI 1: hazard ratio 2.07 (95% confidence interval 1.51–2.85), CCI 2+: 2.34 (1.59–3.44)]; this was not observed for PCSM [CCI 1: 0.79 (0.50–1.23), CCI 2+: 0.97 (0.59–1.59)]. In addition, comorbidities had a greater impact on the patients’ mortality than age.

Conclusions

The results of the current study suggest that chronological age is a stronger predictor of treatment choices than comorbidities, although comorbidities have a larger influence on patients’ mortality. Hence, inclusion of comorbidities in treatment choices may provide more appropriate treatment for PCa patients to counteract over- or undertreatment.

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