Comorbidity and survival of Danish prostate cancer patients from 2000–2011: a population-based cohort study
Authors Nguyen-Nielsen M, Nørgaard M, Jacobsen JB, Borre M, Thomsen RW, Søgaard M
Received 1 May 2013
Accepted for publication 6 June 2013
Published 1 November 2013 Volume 2013:5(Supplement 1 Comorbidity and Cancer Survival) Pages 47—55
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Mary Nguyen-Nielsen,1 Mette Nørgaard,1 Jacob Bonde Jacobsen,1 Michael Borre,2 Reimar Wernich Thomsen,1 Mette Søgaard1
1Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; 2Department of Urology, Aarhus University Hospital, Aarhus, Denmark
Objective: We investigated temporal changes in overall survival among prostate cancer (PC) patients and the impact of comorbidity on all-cause mortality.
Methods: We conducted a population-based cohort study in the Central Denmark Region (1.2 million inhabitants). Using medical registries, we identified 7,654 PC patients with first-time PC diagnosis within the period 2000–2011 and their corresponding comorbidities within 10 years prior to the PC diagnosis. We estimated 1- and 5-year survival in four consecutive calendar periods using a hybrid analysis and plotted Kaplan–Meier survival curves. We used Cox proportional hazards regression to compute 1- and 5-year age-adjusted mortality rate ratios (MRRs) for different comorbidity levels. All estimates are reported with their corresponding 95% confidence intervals (CI).
Results: The annual number of PC cases doubled over the 12-year study period. Men aged <70 years accounted for the largest proportional increase (from 33% to 47%). The proportion of patients within each comorbidity category remained constant over time. One-year survival increased from 82% (CI: 80%–84%) in 2000–2002 to 92% (CI: 90%–93%) in 2009–2011, while 5-year survival increased from 43% (CI: 40%–46%) to 65% (CI: 62%–67%) during the same time intervals. Improvements in 5-year survival were most prominent among patients aged <80 years and among those with no comorbidity (from 51% to 73%) and medium comorbidity (from 32% to 54%). Improvements in survival were much smaller for those with high comorbidity (from 33% to 39%). The 1-year age-adjusted MRR for patients with high comorbidity (relative to patients with no comorbidity) increased over time from 1.84 (CI: 1.19–2.84) to 3.67 (CI: 2.49–5.41), while the 5-year age-adjusted MRR increased from 1.73 (CI: 1.34–2.23) to 2.38 (CI: 1.93–2.94).
Conclusion: Overall survival of PC improved substantially during 2000–2011, although primarily among men with low comorbidity. All-cause mortality was highest among PC patients with high comorbidity, and their relative 1- and 5-year mortality increased over time compared to those without comorbidity.
Keywords: prostate cancer, comorbidities, Charlson Index, survival
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