Population-based assessment of cancer-specific mortality after local XXXX ablation or observation for @entity703 : a competing risks analysis.

@entity5 @entity1 @entity703
OBJECTIVES: To examine, using competing risks regression, differences in cancer-specific mortality (CSM) that might distinguish between local @entity5 ablation (LTA) and observation (OBS) for @entity1 with @entity703 . @entity1 AND METHODS: The study focused on 1 860 @entity1 with cT1a @entity703 treated with either LTA or OBS between 2000 and 2009 in the Surveillance Epidemiology and End Results-Medicare database. Propensity-score matching was used. The study outcome was CSM. Multivariable competing risks regression analyses, adjusting for other-cause mortality as well as @entity1 (including comorbidities) and @entity5 characteristics, were fitted. RESULTS: Overall, fewer @entity1 underwent LTA than OBS (30 vs 70%; n = 553 vs n = 1 307). Compared with @entity1 in the OBS group, those in the LTA group were younger (median age 77 vs 78 years; P < 0.001), more likely to be white (84 vs 78%; P = 0.005), more frequently married (59 vs 52%; P = 0.02) and more frequently of high socio-economic status (54 vs 45%; P = 0.001). After propensity-score matching, 553 @entity1 who underwent LTA and 553 who underwent OBS remained for subsequent analyses. The mean standardized differences of @entity1 characteristics between the two groups were <10%, indicating a high degree of similarity. After LTA or OBS, the 5-year CSM estimates from Poisson regression-derived smoothed plots were 3.5 and 9.1%, respectively. In multivariable competing risks regression analyses, LTA use was found to have a protective effect on CSM (hazard ratio 0.47 [95% confidence interval 0.25-0.89]; P = 0.02). CONCLUSIONS: After adjustment for @entity5 characteristics in elderly @entity1 with @entity703 , LTA was associated with a clinically and statistically significant protective effect on CSM, compared with OBS. This advantage of LTA deserves consideration when obtaining informed consent.
