Level of education and mortality after radical prostatectomy

被引:7
作者
Froehner, Michael [1 ]
Koch, Rainer [2 ]
Propping, Stefan [1 ]
Liebeheim, Dorothea [1 ]
Huebler, Matthias [3 ]
Baretton, Gustavo B. [4 ]
Hakenberg, Oliver W. [5 ]
Wirth, Manfred P. [1 ]
机构
[1] Tech Univ Dresden, Dept Urol Univ Hosp, Fetscherstrasse 74, D-01307 Dresden, Germany
[2] Tech Univ Dresden, Univ Hosp, Dept Med Stat & Biometry, Fetscherstrasse 74, D-01307 Dresden, Germany
[3] Tech Univ Dresden, Univ Hosp, Dept Anesthesiol, Fetscherstrasse 74, D-01307 Dresden, Germany
[4] Tech Univ Dresden, Univ Hosp, Dept Pathol, Fetscherstrasse 74, D-01307 Dresden, Germany
[5] Univ Rostock, Dept Urol, Ernst Heydemann Str 6, D-18055 Rostock, Germany
关键词
comorbidity; competing risk analysis; level of education; life expectancy; mortality; proportional hazards model; prostate cancer; radical prostatectomy; smoking; socioeconomic status; BODY-MASS INDEX; LIFE EXPECTANCY; SOCIOECONOMIC INEQUALITIES; CANCER; OBESITY; COHORT; OVERWEIGHT; SMOKING; MEN; ASSOCIATION;
D O I
10.4103/1008-682X.178487
中图分类号
R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
摘要
Estimating the risk of competing mortality is of importance in men with early prostate cancer to choose the most appropriate way of management and to avoid over-or under-treatment. In this study, we investigated the impact of the level of education in this context. The study sample consisted of 2630 patients with complete data on level of education (college, university degree, master craftsmen, comparable profession, or others), histopathological tumor stage (organ confined or extracapsular), lymph node status (negative or positive), and prostatectomy specimen Gleason score (< 7, 7, or 8-10) who underwent radical prostatectomy between 1992 and 2007. Overall, prostate cancer-specific, competing, and second cancer-related mortalities were study endpoints. Cox proportional hazard models for competing risks were used to study combined effects of the variables on these endpoints. A higher level of education was independently associated with decreased overall mortality after radical prostatectomy (hazard ratio [HR]: 0.75, 95% confidence interval [95% CI]: 0.62-0.91, P = 0.0037). The mortality difference was attributable to decreased second cancer mortality (HR: 0.59, 95% CI: 0.40-0.85, P = 0.0052) and noncancer mortality (HR: 0.73, 95% CI: 0.55-0.98, P = 0.0345) but not to differences in prostate cancer-specific mortality (HR: 1.16, 95% CI: 0.79-1.69, P = 0.4536 in the full model). In conclusion, the level of education might serve as an independent prognostic parameter supplementary to age, comorbidity, and smoking status to estimate the risk of competing mortality and to choose optimal treatment for men with early prostate cancer who are candidates for radical prostatectomy.
引用
收藏
页码:173 / 177
页数:5
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