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Abstract

Volume 19, Issue 2 (March 2017) 19, 173–177; 10.4103/1008-682X.178487

Level of education and mortality after radical prostatectomy

Michael Froehner1, Rainer Koch2, Stefan Propping1, Dorothea Liebeheim1, Matthias Hübler3, Gustavo B Baretton4, Oliver W Hakenberg5, Manfred P Wirth1

1 Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
2 Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
3 Department of Anesthesiology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
4 Department of Pathology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
5 Department of Urology, University of Rostock, Ernst-Heydemann-Strasse 6, D-18055 Rostock, Germany

Correspondence: Dr. M Froehner (michael.froehner@uniklinikum-dresden.de)

Date of Submission 14-Sep-2015 Date of Decision 03-Dec-2015 Date of Acceptance 29-Jan-2016 Date of Web Publication 27-Dec-2016

Abstract

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.

Keywords: comorbidity; competing risk analysis; level of education; life expectancy; mortality; proportional hazards model; prostate cancer; radical prostatectomy; smoking; socioeconomic status

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