scholarly journals Prostate Cancer Survival and Mortality according to a 13-year retrospective cohort study in Brazil: Competing-Risk Analysis

2021 ◽  
Vol 24 ◽  
Author(s):  
Sonia Faria Mendes Braga ◽  
Rumenick Pereira da Silva ◽  
Augusto Afonso Guerra Junior ◽  
Mariangela Leal Cherchiglia
Keyword(s):  
Prostate Cancer ◽  
Cancer Survival ◽  
Stage Iv ◽  
Competing Risk ◽  
Factors Associated ◽  
Risk Of Death ◽  
Unified Health System ◽  
Cancer Specific Mortality ◽  
Main Factors ◽  
Integrate Data

ABSTRACT: Objective: To analyze cancer-specific mortality (CSM) and other-cause mortality (OCM) among patients with prostate cancer that initiated treatment in the Brazilian Unified Health System (SUS), between 2002 and 2010, in Brazil. Methods: Retrospective observational study that used the National Oncological Database, which was developed by record-linkage techniques used to integrate data from SUS Information Systems, namely: Outpatient (SIA-SUS), Hospital (SIH-SUS), and Mortality (SIM-SUS). Cancer-specific and other-cause survival probabilities were estimated by the time elapsed between the date of the first treatment until the patients’ deaths or the end of the study, from 2002 until 2015. The Fine-Gray model for competing risk was used to estimate factors associated with patients’ risk of death. Results: Of the 112,856 studied patients, the average age was 70.5 years, 21% died due to prostate cancer, and 25% due to other causes. Specific survival in 160 months was 75%, and other-cause survival was 67%. For CSM, the main factors associated with patients’ risk of death were: stage IV (AHR = 2.91; 95%CI 2.73 - 3.11), systemic treatment (AHR = 2.10; 95%CI 2.00 - 2.22), and combined surgery (AHR = 2.30, 95%CI 2.18 - 2.42). As for OCM, the main factors associated with patients’ risk of death were age and comorbidities. Conclusion: The analyzed patients with prostate cancer were older and died mainly from other causes, probably due to the presence of comorbidities associated with the tumor.

scholarly journals Patient survival and risk of death after prostate cancer treatment in the Brazilian Unified Health System

2017 ◽  
Vol 51 (0) ◽  
Author(s):  
Sonia Faria Mendes Braga ◽  
Mirian Carvalho de Souza ◽  
Raphael Romie de Oliveira ◽  
Eli Iola Gurgel Andrade ◽  
Francisco de Assis Acurcio ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health System ◽  
Cancer Treatment ◽  
Clinical Staging ◽  
National Database ◽  
Patient Death ◽  
Factors Associated ◽  
Risk Of Death ◽  
Unified Health System ◽  
Increased Risk

ABSTRACT OBJECTIVE Analyze the probability of specific survival and factors associated with the risk of death of patients with prostate cancer who received outpatient cancer treatment in the Brazilian Unified Health System, Brazil. METHODS Retrospective cohort study using the National Database of Oncology, developed through the deterministic-probabilistic pairing of health information systems: outpatient (SIA), hospital (SIH) and mortality (SIM). The probability of overall and specific survival was estimated by the time elapsed between the date of the first ambulatory treatment, from 2002 to 2003, until the patient’s death or the end of the study. Fine and Gray’s model of competing-risks regression was adjusted according to the variables: age of diagnostic, region of residence, tumor clinical staging, type of outpatient cancer treatment and hospitalization in the assessment of factors associated with risk of patient death. RESULTS Of 16,280 patients studied, the average age was 70 years, approximately 25% died due to prostate cancer and 20% for other causes. The probability of overall survival was 0.50 (95%CI 0.49–0.52) and the specific was 0.70 (95%CI 0.69–0.71). The factors associated with the risk of patient death were: stage III (HR = 1.66; 95%CI 1.39–1.99) and stage IV (HR = 3.49; 95%CI 2.91–4.18), chemotherapy (HR = 2.34; 95%CI 1.76–3.11) and hospitalization (HR = 1.6; 95%CI 1.55–1.79). CONCLUSIONS The late diagnosis of the tumor, palliative treatments, and worse medical condition were factors related to the worst survival and increased risk of death from prostate cancer patients in Brazil.

Early detection of high-grade prostate cancer using digital rectal examination in men with a normal PSA and risk of death.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 147-147
Author(s):  
Jona Ashok Hattangadi ◽  
Ming-Hui Chen ◽  
Leon Sun ◽  
Anthony Victor D'Amico
Keyword(s):  
Prostate Cancer ◽  
Locally Advanced ◽  
Digital Rectal Examination ◽  
High Grade ◽  
White Race ◽  
Factors Associated ◽  
Rectal Examination ◽  
Risk Of Death ◽  
Increased Risk ◽  
Multivariable Regression

147 Background: A digital rectal examination (DRE) is less commonly practiced in the PSA screening era. Whether detection of high-grade prostate cancer (PC) while still clinically localized on DRE can improve survival in men with a normal PSA is unknown. Methods: From the Surveillance, Epidemiology and End Results database, 166,498 men with PC diagnosed between 2004-2008 were identified. Logistic regression was used to identify factors associated with the occurrence of palpable, PSA-occult (PSA <2.5 ng/ml) and Gleason score (GS) 8-10 PC. Factors examined included age at and year of diagnosis and race. Fine and Grays and Cox multivariable regression were performed to analyze whether these factors, treatment and known prognostic factors were associated with the risk of PC-specific mortality (PCSM) and all-cause mortality (ACM), respectively. Results: Of 166,498, 685 men (0.4%) had palpable, PSA-occult and GS 8 to 10 PC. Median age and PSA at diagnosis in this group were 68 years [IQR: 61-75] and 1.5 ng/ml [IQR: 1-2], respectively. Most (83%) men were white. Both increasing age (adjusted odds ratio (AOR): 1.02 [95% confidence interval (CI) 1.01-1.03]; p<0.0001) and white race (AOR: 1.26 [95% CI 1.03-1.54]; p =0.03) were associated with palpable, Gleason 8 to 10 PC with normal PSA. Significant factors associated with an increased risk of PCSM and ACM in this cohort are shown in the table. For these 685 men, detecting locally advanced as compared to localized PC on DRE was associated with a significantly lower survival (p = 0.0001). Conclusions: Detecting PSA-occult high-grade PC with DRE while disease remains clinically localized amongst high-risk men (over age 68 and white race) has the potential to improve survival. [Table: see text]

On the road again: Travel patterns and outcomes in rectal cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 530-530
Author(s):  
Mary Kledzik ◽  
Anthony Joseph Scholer ◽  
Adam Khader ◽  
Juan Santamaria-Barria ◽  
Trevan D Fischer ◽  
...  
Keyword(s):  
Hospital Volume ◽  
Rectal Adenocarcinoma ◽  
Stage Iv ◽  
Travel Distance ◽  
Stage I ◽  
Factors Associated ◽  
Risk Of Death ◽  
Improved Outcomes ◽  
Increased Risk ◽  
The Impact

530 Background: Associations between high volume centers and outcomes have many advocating for centralization of cancer care, which can lead to increased travel, patient burden, and cost. There is, however, some conflicting data regarding outcomes for patients with more advanced disease. This study aims to explore factors associated with travel and the impact on survival for patients receiving surgery for rectal adenocarcinoma. Methods: All patients >18 years of age with rectal adenocarcinoma that had a surgical resection were identified using the National Cancer Database from 2004-2014. Univariate and multivariate (MV) regression analyses determined factors associated with increased travel distance (<50 miles, 50-100 miles, >100 miles) as well as the impact of travel on overall survival (OS). Results: Of 83,933 patients, those that traveled the furthest were more commonly younger, white non-Hispanic, insured, and with less comorbidities (all p<0.05 on MV analysis). Cancer stage, surgical approach, and type of surgery were not associated with travel distance (p=NS). Increased travel distance improved 5-year OS for stage IV disease (10%, p=0.002), and trended toward significance for stage II (4.0%, p=0.06) and stage 1 (4.3%, p=0.09) disease. After controlling for other factors, travel distance did not impact OS for stage II/III disease, but stage I and IV patients traveling 50-100 miles had an increased risk of death (stage I HR 1.16, CI 1.04-1.30; stage IV HR 1.19, CI 1.07-1.32). This was similar in the entire cohort where traveling 50-100 miles had an increased risk of death (HR 1.09; CI 1.03-1.14). Patients treated at non-low volume centers did have improved outcomes across all stages (p<0.01). Patients treated in academic hospitals had improved outcomes in stages I and IV (p=0.02). Conclusions: Younger, white, non-Hispanic patients are most likely to travel longer distances for rectal cancer treatment, regardless of stage. Increased hospital volume improves OS while travel and use of academic centers may impact patients with stage I/IV disease. Educating patients and providers regarding the influence of travel and hospital volume could help reallocate some resources, decrease financial toxicity, and ease the travel burden for patients.

scholarly journals Machine learning based predictive model of early mortality in stage III and IV prostate cancer

2020 ◽  
Author(s):  
Robert Chen
Keyword(s):  
Prostate Cancer ◽  
Machine Learning ◽  
Cancer Survival ◽  
Stage Iv ◽  
Clinical Decision ◽  
Early Mortality ◽  
Stage Iii ◽  
Clinical Endpoints ◽  
Metabolomic Data ◽  
Metastatic Sites

AbstractProstate cancer remains the third highest cause of cancer-related deaths. Metastatic prostate cancer could yield poor prognosis, however there is limited work on predictive models for clinical decision support in stage III and IV prostate cancer.We developed a machine learning model for predicting early mortality in prostate cancer (survival less than 21 months after initial diagnosis). A cohort of 10,303 patients was extracted from the Surveillance, Epidemiology and End Results (SEER) program. Features were constructed in several domains including demographics, histology of primary tumor, and metastatic sites. Feature selection was performed followed by regularized logistic regression. The model was evaluated using 5-fold cross validation and achieved 75.2% accuracy with AUC 0.649. Of the 19 most predictive features, all of them were validated to be clinically meaningful for prediction of early mortality.Our study serves as a framework for prediction of early mortality in patients with stage II and stage IV prostate cancer, and can be generalized to predictive modeling problems for other relevant clinical endpoints. Future work should involve integration of other data sources such as electronic health record and genomic or metabolomic data.

Short-course hormonal therapy and the risk of death from prostate cancer in men with intermediate-risk prostate cancer undergoing high-dose radiation therapy.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 27-27
Author(s):  
Florence K. Keane ◽  
Ming-Hui Chen ◽  
Danjie Zhang ◽  
Brian Joseph Moran ◽  
Michelle H. Braccioforte ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Dose ◽  
Intermediate Risk ◽  
Risk Of Death ◽  
Short Course ◽  
Significant Difference ◽  
Risk Prostate Cancer ◽  
Cancer Specific Mortality ◽  
The Impact

27 Background: We assessed the risk of prostate cancer-specific mortality (PCSM) in men with unfavorable and favorable intermediate-risk prostate cancer (PC) who received dose-escalated radiotherapy (RT) with or without short-course androgen deprivation therapy (ADT). Methods: The cohort consisted of 2,668 men with intermediate-risk PC (71.3% favorable, 28.7% unfavorable) who were treated with dose-escalated RT with or without ADT (median 4 mos.) from 1997 - 2013. Fine and Gray's competing risks regression was used to assess whether ADT decreased PCSM-risk in an adjusted multivariable model (Table). An interaction term was included to assess for potential differences in the impact of ADT on PCSM risk in men with favorable versus unfavorable intermediate-risk PC. Results: After a median follow-up of 7.84 years, there were 393 deaths (14.73%), of which 33 were from PC (8.40%). There was significant reduction in PCSM-risk in men with unfavorable intermediate-risk PC who received ADT (AHR 0.39, 95% CI 0.16 to 0.92, P=0.033), but no significant difference in PCSM-risk in men with favorable intermediate-risk PC who received ADT (AHR 0.68, 95% CI 0.19 to 2.49, P=0.561). Conclusions: While ADT reduced PCSM-risk in men with unfavorable intermediate-risk PC, there was no significant improvement in men with favorable intermediate-risk PC, suggesting that for these patients ADT in addition to dose-escalated RT may not be required to minimize PCSM-risk. [Table: see text]

Abstract 4131: Individual and contextual factors associated with overall prostate cancer survival in Florida

2014 ◽  
Author(s):  
Hong Xiao ◽  
Fei Tan ◽  
Georges Adunlin ◽  
Askal Ali ◽  
Pierre Goovaerts ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Survival ◽  
Contextual Factors ◽  
Factors Associated

scholarly journals Mortality and survival of COVID-19

2020 ◽  
Vol 148 ◽  
Author(s):  
G. J. B. Sousa ◽  
T. S. Garces ◽  
V. R. F. Cestari ◽  
R. S. Florêncio ◽  
T. M. M. Moreira ◽  
...  
Keyword(s):  
Cox Regression ◽  
Neurological Diseases ◽  
Binary Variable ◽  
Historical Cohort ◽  
Factors Associated ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Main Factors ◽  
Brazilian Northeast ◽  
Robust Poisson Regression

Abstract This study aims to identify the risk factors associated with mortality and survival of COVID-19 cases in a state of the Brazilian Northeast. It is a historical cohort with a secondary database of 2070 people that presented flu-like symptoms, sought health assistance in the state and tested positive to COVID-19 until 14 April 2020, only moderate and severe cases were hospitalised. The main outcome was death as a binary variable (yes/no). It also investigated the main factors related to mortality and survival of the disease. Time since the beginning of symptoms until death/end of the survey (14 April 2020) was the time variable of this study. Mortality was analysed by robust Poisson regression, and survival by Kaplan–Meier and Cox regression. From the 2070 people that tested positive to COVID-19, 131 (6.3%) died and 1939 (93.7%) survived, the overall survival probability was 87.7% from the 24th day of infection. Mortality was enhanced by the variables: elderly (HR 3.6; 95% CI 2.3–5.8; P < 0.001), neurological diseases (HR 3.9; 95% CI 1.9–7.8; P < 0.001), pneumopathies (HR 2.6; 95% CI 1.4–4.7; P < 0.001) and cardiovascular diseases (HR 8.9; 95% CI 5.4–14.5; P < 0.001). In conclusion, mortality by COVID-19 in Ceará is similar to countries with a large number of cases of the disease, although deaths occur later. Elderly people and comorbidities presented a greater risk of death.

scholarly journals Competing Risks of Cancer and Non-Cancer Mortality When Accompanied by Lifestyle-Related Factors—A Prospective Cohort Study in Middle-Aged and Older Adults

2020 ◽  
Vol 10 ◽  
Author(s):  
Pawel Macek ◽  
Malgorzata Biskup ◽  
Malgorzata Terek-Derszniak ◽  
Marta Manczuk ◽  
Halina Krol ◽  
...  
Keyword(s):  
Cancer Mortality ◽  
Vigorous Physical Activity ◽  
Competing Risk ◽  
Cancer Death ◽  
Related Factors ◽  
Risk Of Death ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Risk Of Cancer ◽  
The Impact

BackgroundThe study aimed to identify the association between the lifestyle-related factors and the cancer-specific, or non-cancer-specific mortality, when accompanied by a competing risk. Two statistical methods were applied, i.e., cause-specific hazard (CSH), and sub-distribution hazard ratio (SHR). Their respective key advantages, relative to the actual study design, were addressed, as was overall application potential.MethodsSource data from 4,584 residents (34.2% men), aged 45–64 years, were processed using two different families of regression models, i.e., CSH and SHR; principal focus upon the impact of lifestyle-related factors on the competing risk of cancer and non-cancer mortality. The results were presented as hazard ratios (HR) with 95% confidence intervals (95% CI).ResultsAge, smoking status, and family history of cancer were found the leading risk factors for cancer death; the risk of non-cancer death higher in the elderly, and smoking individuals. Non-cancer mortality was strongly associated with obesity and hypertension. Moderate to vigorous physical activity decreased the risk of death caused by cancer and non-cancer causes.ConclusionsSpecific, lifestyle-related factors, instrumental in increasing overall, and cancer-specific mortality, are modifiable through health-promoting, individually pursued physical activities. Regular monitoring of such health-awareness boosting pursuits seems viable in terms of public health policy making.

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