710 844
Brief Correspondence
Predicting Competing Mortality in Patients Undergoing Radical
Prostatectomy Aged 70 yr or Older
Michael Froehner
a , * ,Rainer Koch
b ,Matthias Hu¨bler
c ,Stefan Zastrow
a ,Manfred P. Wirth
aa
Department of Urology, University Hospital Carl Gustav Carus, Technische Universita¨t Dresden, Dresden, Germany;
b
Department of Medical Statistics and
Biometry, University Hospital Carl Gustav Carus, Technische Universita¨t Dresden, Dresden, Germany;
c
Department of Anesthesiology, University Hospital
Carl Gustav Carus, Technische Universita¨t Dresden, Dresden, Germany
Long-living elderly men may benefit from prostate cancer
screening and from more active treatment. Therefore,
estimating the risk of competing mortality is of paramount
importance
[1–4]. There is, however, no generally accepted
tool for this purpose
[1]. For patients selected for radical
prostatectomy aged 70 yr or older, a stricter selection of
favorable risks may influence the prognostic significance of
individual risk factors for competing mortality. In this
study, we investigated the impact of this selection process
on the prognostic significance of comorbid conditions and
related parameters.
Using proportional hazard models for the subdistribu-
tion of competing risks according to Fine and Gray, we
studied 2961 consecutive patients treated at our institution
E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 7 1 0 – 7 1 3available at
www.scienced irect.comjournal homepage:
www.europeanurology.comArticle info
Article history:
Accepted October 13, 2016
Associate Editor:
Giacomo Novara
Keywords:
Urologic neoplasms
Age
Comorbidity
Prostate cancer
Radical prostatectomy
Mortality
Competing risk analysis
Selection
Abstract
Estimating the risk of competing mortality is of importance in tailoring optimal
individual management strategies in patients with early prostate cancer. Using propor-
tional hazard models for competing risks, we determined which parameters predict
competing mortality in patients selected for radical prostatectomy aged 70 yr or older
and compared the prognostic impact of individual parameters with that of their younger
counterparts. Three common diseases (diabetes mellitus, chronic lung disease, and other
cancer) that predicted competing mortality in younger men were not predictors of
competing mortality in men selected for radical prostatectomy aged 70 yr or older
(hazard ratio [HR]:
<
1). Besides age (HR/yr: 1.08,
p
= 0.0255), peripheral vascular
disease (HR: 2.33,
p
= 0.0195), cerebrovascular disease (HR: 2.23,
p
= 0.0242), American
Society of Anesthesiologists physical status class 3 (HR: 2.19,
p
<
0.0001), current
smoking (HR: 2.18,
p
= 0.0098), and lower or unknown level of education (HR: 2.07,
p
= 0.0002) were independent predictors of competing mortality in patients aged 70 yr
or older. Combining these five conditions in a score might provide a superior comorbidi-
ty measure in this particular population.
Patient summary:
Stricter selection may diminish the prognostic significance of several
common diseases in men selected for radical prostatectomy aged 70 yr or older whereas
other parameters (peripheral vascular disease, cerebrovascular disease, American Soci-
ety of Anesthesiologists physical status class 3, current smoking, and level of education)
sustained their meaningfulness and should be taken into consideration when the risk of
competing mortality is estimated.
#
2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Department of Urology, University Hospital Carl Gustav Carus, Technische
Universita¨t Dresden, Fetscherstrasse 74, Dresden D-01307, Germany. Tel. +49-351-4587462;
Fax: +49-351-4584333.
E-mail address:
Michael.Froehner@uniklinikum-dresden.de(M. Froehner).
http://dx.doi.org/10.1016/j.eururo.2016.10.0220302-2838/
#
2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.