IRCCS Policlinico San Martino Hospital - University of Genova
Introduction: To compare overall mortality (OM), cancer specific mortality (CSM) and other cause mortality (OCM) rates between radical prostatectomy (RP) vs. radiotherapy (RT) in clinical node positive (cN1) prostate cancer (PCa).
Methods: Within Surveillance, Epidemiology, End Results (SEER) (2010-2016), we identified 4,685 cN1 PCa patients, of whom 3,589 (76.6%) vs 1,096 (24.4%) were treated with RP vs RT. After 1:1 propensity score matching (PSM) (age, PSA, T stage and biopsy Gleason grade group), Kaplan-Meier plots and Cox regression models (Figure 1) tested the effect of RP vs RT on OM, while cumulative incidence plots and competing-risks regression models addressed CSM and OCM between RP and RT patients. All analyses were repeated after inverse probability of treatment weighting (IPTW, Figure 2).
Results: Overall, RT patients were older, harbored higher PSA values, higher clinical T and higher Gleason grade groups. PSM resulted in two equally sized groups of 894 RP vs. 894 RT patients. After PSM, 5-year OM, CSM and OCM rates were respectively 15.4 vs 25%, 9.3 vs. 17%, and 6.1 vs 8% for RP vs RT (all p<0.001) and yielded respective multivariate HRs of 0.63 (0.52-0.78, p<0.001), 0.66 (0.52-0.86, p<0.001), 0.71 (0.5-1.0, p=0.05), all favoring RP. After IPTW, Cox regression models yielded HR of 0.55 (95% CI 0.46-0.66), 0.54 (0.46-0.68) and 0.58 (0.43-0.77) for respectively OM, CSM and OCM, all favoring RP (all p<0.001).
Conclusions: RP may hold a CSM advantage over RT in cN1 PCa patients.
.jpg)
.jpg)
