Sains Malaysiana 50(5)(2021): 1367-1379

http://doi.org/10.17576/jsm-2021-5005-16

 

Survival Analysis and Prognostic Factors for Prostate Cancer Patients at Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur

(Analisis Kemandirian dan Faktor Prognostik bagi Pesakit Kanser Prostat di Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur)

 

SHAMSUL AZHAR SHAH*, NORZAHER ISMAIL, SYAFIQ TAIB, SITI NOR MAT & NAZARUDIN SAFIAN

 

Department of Community Health, Hospital Canselor Tuanku Muhriz UKM-Medical Centre, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

 

Diserahkan: 17 Julai 2019/Diterima: 28 September 2020

 

ABSTRACT

Prostate cancer is the third commonest type of cancer in Malaysian men with the incidence of 1,807 in 2018 compared to 1,186 cases reported in 2014. Prostate cancer is also known to cause disease, economic burden and lead to significant financial implications for the healthcare system. This study aimed to measure the rate of survival and to determine the prognostic factors for prostate cancer patients at Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur. This was a retrospective study design involving prostate cancer patients who had been diagnosed and had sought treatment at Universiti Kebangsaan Malaysia Medical Centre from 2008 to 2017. Data were obtained from the patients’ medical records based on TRUS biopsy. The study period was from July 2017 to December 2018. Survival probabilities were estimated using Kaplan-Meier, and differences were compared using the log-rank test. The adjusted hazard ratio (HR) for variables was estimated after fitting the Cox proportion hazard model. Patients' death status due to prostate cancer was the endpoint of the survival analysis. A total of 283 patients’ data were analysed. Total five-year and ten-year survival rates of prostate cancer patients were 77.8 and 65.5%, respectively, regardless of the stage and treatment. The predictor factors for survival age were ≥75 years (HR = 8.49, 95% C.I: 1.16-62.13), Gleason score ≥8 (HR = 2.36, 95% C.I: 1.18-4.73) and cancer metastasis complications (HR = 5.26, 95% C.I: 2.88-9.63). Survival rates and prognostic factors of prostate cancer in the study were almost similar to those in nearby countries in the region. Preventive actions such as prostate cancer screening, early detection of cancer and early treatment should be empowered to improve the survival rate of prostate cancer patients in this hospital.

 

Keywords: Prognostic factor; prostate cancer; survival analysis

 

ABSTRAK

Kanser prostat ialah jenis kanser yang ketiga tertinggi di kalangan lelaki Malaysia dengan kadar insiden 1,807 kes pada tahun 2018 berbanding 1,186 kes pada tahun 2014. Kanser prostat juga diketahui sebagai punca beban penyakit, beban ekonomi dan menyebabkan implikasi kewangan yang signifikan kepada sistem penjagaan kesihatan. Kajian ini bertujuan untuk mengukur kadar kemandirian dan menentukan faktor prognostik untuk pesakit kanser prostat di Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur. Reka bentuk kajian adalah retrospektif yang melibatkan pesakit kanser prostat yang telah didiagnos dan mendapatkan rawatan di UKMMC dari 2008 hingga 2017. Data diperoleh daripada rekod perubatan pesakit berdasarkan biopsi kelenjar prostat. Tempoh kajian adalah dari Julai 2017 sehingga Disember 2018. Kadar kemandirian dianggarkan menggunakan Kaplan-Meier dan perbezaannya dibandingkan dengan ujian Log-Rank. Nisbah Hazard untuk pemboleh ubah dianggarkan menggunakan Model Hazad Berkadaran Cox. Status kematian pesakit akibat kanser prostat adalah titik akhir analisis kemandirian hidup. Sebanyak 283 data pesakit dianalisis. Jumlah pesakit kanser prostat sepanjang 5 tahun dan 10 tahun adalah 77.8 dan 65.5% tanpa mengira tahap dan jenis rawatan. Faktor prognostik untuk kemandirian hidup adalah umur ≥ 75 tahun (NH = 8.49, 95% SK 1.16-62.13), skor Gleason ≥ 8 (NH = 2.36 95% SK 1.18-4.73) dan komplikasi metastasis kanser (NH = 5.26 95% SK 2.88 -9.63). Kadar kemandirian dan faktor prognostik kanser prostat dalam kajian ini hampir sama dengan negara berdekatan di rantau ini. Tindakan pencegahan seperti pemeriksaan kanser prostat, pengesanan awal kanser dan rawatan awal harus diberi fokus untuk meningkatkan kadar kemandirian hidup pesakit kanser prostat di hospital ini.

 

Kata kunci: Analisis kemandirian; faktor prognostik; kanser prostat

 

RUJUKAN

 

Bechis, S.K., Carroll, P.R. & Cooperberg, M.R. 2011. Impact of age at diagnosis on prostate cancer treatment and survival. Journal of Clinical Oncology 29(2): 235-241.

Bill-Axelson, A., Holmberg, L., Ruutu, M., Garmo, H., Stark, J.R., Busch, C., Nordling, S., Häggman, M., Andersson, S.O., Bratell, S. & Spångberg, A. 2011. Radical prostatectomy versus watchful waiting in early prostate cancer. New England Journal of Medicine 364(18): 1708-1717.

Braga, S.F.M., Souza, M.C.D., Oliveira, R.R.D., Andrade, E.I.G., Acurcio, F.D.A. & Cherchiglia, M.L. 2017. Patient survival and risk of death after prostate cancer treatment in the Brazilian Unified Health System. Revista de Saude Publica 51: 46.

Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R.L., Torre, L.A. & Ahmedin Jemal. 2018. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 68(6): 394-424.

Bumpus, H.C. 1926. Carcinoma of the prostate: A clinical study of one thousand cases. Surgery, Gynecology and Obstetrics 43: 150-155.

Chodak, G.W., Thisted, R.A., Gerber, G.S., Johansson, J.E., Adolfsson, J., Jones, G.W., Chisholm, G.D., Moskovitz, B., Livne, P.M. & Warner, J. 1994. Results of conservative management of clinically localized prostate cancer. New England Journal of Medicine 330(4): 242-248.

Collette, L., de Reijke, T.M., Schröder, F.H. & EORTC Genito-Urinary Group. 2003. Prostate specific antigen: A prognostic marker of survival in good prognosis metastatic prostate cancer? (EORTC 30892). European Urology 44(2): 182-189.

Davidson, P.J., Hop, W., Kurth, K.H., Fossa, S.D., Waehre, H. & Schroder, F.H. 1995.    Progression in untreated carcinoma of the prostate metastatic to regional lymph nodes (stage T0 to 4, N1 to 3, M0, D1). The Journal of Urology 154(6): 2118-2122.

Denis, L.J., Keuppens, F., Smith, P.H., Whelan, P., de Moura, J.C., Newling, D., Bono, A. & Sylvester, R. 1998. Maximal androgen blockade: Final analysis of EORTC phase III trial 30853. European Urology 33(2): 144-151.

Egevad, L., Granfors, T., Karlberg, L., Bergh, A. & Stattin, P. 2002. Prognostic value of the Gleason score in prostate cancer. British Journal of Urology International 89(6): 538-542.

Ezat, S.W.P., Junid, S.M.A.S., Khamis, N., Ahmed, Z., Sulong, S., Nur, A.M., Aizuddin, A.N., Ismail, F., Abdullah, N., Zainuddin, Z.M. & Kassim, A.Y.M. 2013. Skeletal-related events among breast and prostate cancer patients: Towards new treatment initiation in Malaysia's hospital setting. Asian Pacific Journal of Cancer Prevention 14(5): 3357-3362.

Ferlay, J., Soerjomataram, I., Ervik, M., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., Parkin, D.M., Forman, D. & Bray, F. 2012. GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012. International Journal Cancer 136: E359-E386.

Fosså, S.D., Fredrik, W., Olbjørn, K., Anders, A., Arne, S., Jan-Erik, D., Morten, H., Anders, W. & The Scandinavian Prostate Cancer Group-7 Investigators 2016. Ten-and 15-yr prostate cancer-specific mortality in patients with nonmetastatic locally advanced or aggressive intermediate prostate cancer, randomized to lifelong endocrine treatment alone or combined with radiotherapy: Final results of the Scandinavian Prostate Cancer Group-7. European Urology 70(4): 684-691.

Glass, T.R., Tangen, C.M., Crawford, E.D. & Thompson, I.A.N. 2003. Metastatic carcinoma of the prostate: Identifying prognostic groups using recursive partitioning. The Journal of       Urology 169(1): 164-169.

Grönberg, H., Damber, L., Jonson, H. & Damber, J.E. 1997. Prostate cancer mortality in northern Sweden, with special reference to tumor grade and patient age. Urology 49(3): 374-378.

He, J. & Chen, W. 2012. Chinese Cancer Registry Annual Report 2012. Beijing: China Military Medical Science Press.

Hittelman, A.B., Purohit, R.S. & Kane, C.J. 2004. Update of staging and risk assessment for prostate cancer patients. Current Opinion in Urology 14(3): 163-170.

Hong, G.E., Kong, C.H., Singam, P., Cheok, L.B., Zainuddin, Z.M. & Azrif, M. 2010. Seven-year review of prostate carcinomas diagnosed by TRUS biopsy in a single Malaysian institution. Asian Pacific Journal of Cancer Prevention 11(5): 1351-1353.

Johansson, J.E., Andrén, O., Andersson, S.O., Dickman, P.W., Holmberg, L., Magnuson, A. & Adami, H.O. 2004. Natural history of early, localized prostate cancer. JAMA 291(22): 2713-2719.

Kishan, A.U., Shaikh, T., Wang, P.C., Reiter, R.E., Said, J., Raghavan, G., Nickols, N.G., Aronson, W.J., Sadeghi, A., Kamrava, M. & Demanes, D.J. 2017. Clinical outcomes for patients with Gleason score 9-10 prostate adenocarcinoma treated with radiotherapy or radical prostatectomy: A multi-institutional comparative analysis. European Urology 71(5): 766-773.

Lim, G.C.C. 2002. Overview of cancer in Malaysia. Japanese Journal of Clinical Oncology 32(1): 37-42.

Malaysia National Cancer Registry 2007.

Nesbit, R.M. 1946. Prostatic carcinoma: A follow-up on 795 patients treated prior to the endocrine era and a comparison of survival rates between these and patients treated by endocrine therapy. Surgery 20: 263-272.

Phanphaisarn, A., Patumanond, J., Settakorn, J., Chaiyawat, P. & Klangjorhor, J. 2016. Prevalence and survival patterns of patients with bone metastasis from common cancers in Thailand. Asian Pacific Journal of Cancer Prevention 17(9): 4335-4340.

Ramsey, S.D., Zeliadt, S.B., Hall, I.J., Ekwueme, D.U. & Penson, D.F. 2007. On the importance of race, socioeconomic status and comorbidity when evaluating quality of life in men with prostate cancer. The Journal of Urology 177(6): 1992-1999.

Robinson, D. 2008. Prediction of survival in prostate cancer aspects on localized, locally advanced and metastatic disease. Ph.D. Thesis. Linkoping University (Unpublished).

Sandblom, G., Dufmats, M. & Varenhorst, E. 2000. Long-term survival in a Swedish population-based cohort of men with prostate cancer. Urology 56(3): 442-447.

Satoh, T., Ledesma, D. & Yoshihara, N. 2018. The economic burden of metastatic castration resistant prostate cancer and skeletal related events in Japanese University Hospitals. Asian Pacific Journal of Cancer Prevention 19(1): 21.

Subahir, M.N., Shah, S.A. & Zainuddin, Z.M. 2009. Risk factors for prostate cancer in Universiti Kebangsaan Malaysia Medical Centre: A case-control study. Asian Pacific Journal of Cancer Prevention 10(6): 1015-1020.

Sun, L., Caire, A.A., Robertson, C.N., George, D.J., Polascik, T.J., Maloney, K.E., Walther, P.J., Stackhouse, D.A., Lack, B.D., Albala, D.M. & Moul, J.W. 2009. Men older than 70 years have higher risk prostate cancer and poorer survival in the early and late prostate specific antigen eras. The Journal of Urology 182(5): 2242-2249.

Wallis, C.J., Mahar, A.L., Choo, R., Herschorn, S., Kodama, R.T., Shah, P.S., Danjoux, C., Narod, S.A. & Nam, R.K. 2016. Second malignancies after radiotherapy for prostate cancer: Systematic review and meta-analysis. British Medical Journal 352(8047): 1-11.

Wilt, T.J. 2012. The prostate cancer intervention versus observation trial: VA/NCI/AHRQ cooperative studies program# 407 (PIVOT): Design and baseline results of a randomized controlled trial comparing radical prostatectomy with watchful waiting for men with clinically localized prostate cancer. Journal of the National Cancer Institute Monographs 2012(45): 184-190.

Wilt, T.J., Brawer, M.K., Jones, K.M., Barry, M.J., Aronson, W.J., Fox, S., Gingrich, J.R., Wei,   J.T., Gilhooly, P., Grob, B.M. & Nsouli, I. 2012. Radical prostatectomy versus observation for localized prostate cancer. New England Journal of Medicine 367: 203-213.

World Health Organization on Cancer report 2014.

Wright, J.L., Salinas, C.A., Lin, D.W., Kolb, S., Koopmeiners, J., Feng, Z. & Stanford, J.L. 2009. Differences in prostate cancer outcomes between cases with Gleason 4+3 and Gleason 3+4 tumors in a population-based cohort. The Journal of Urology 182(6): 2702- 2707.

Zagars, G.K., Sands, M.E., Pollack, A. & von-Eschenbach, A.C. 1994. Early androgen ablation for stage D1 (N1 to N3, M0) prostate cancer: prognostic variables and outcome. The Journal of Urology 151(5): 1330-1333.

Zahir, S.T., Nazemian, M.R., Zand, S. & Zare, S. 2014. Survival of patients with prostate cancer in Yazd, Iran. Asian Pacific Journal of Cancer Prevention 15(2): 883-886.

 

*Pengarang untuk surat-menyurat; email: drsham@ppukm.ukm.edu.my

 

 

 

 

sebelumnya