Evidence map›Paper›PMID 32989262›Full record

ArticleProstate cancer and prostatic diseases2021

Quantifying treatment selection bias effect on survival in comparative effectiveness research: findings from low-risk prostate cancer patients.

Joseph A Miccio, Wesley J Talcott, Vikram Jairam, Henry S Park, James B Yu, Michael S Leapman, Skyler B Johnson, Martin T King, Paul L Nguyen, Benjamin H Kann

Registry-linked trialAbstract read
PubMed Publisher
In one paragraph

Article in Prostate cancer and prostatic diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03445559 (A Multi-modal, Physician-centered Intervention to Improve Guideline-concordant Prostate Cancer Imaging), which is not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03445559 naactive not recruitingnot on this map

A Multi-modal, Physician-centered Intervention to Improve Guideline-concordant Prostate Cancer Imaging

TypeinterventionalSponsorVA Office of Research and DevelopmentRan2018 to 2027Enrolled58ConditionsProstate CancerArmsClinical Order Check, Academic Detailing, Audit and Feedback
3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Radical prostatectomy is associated with favorable outcomes in patients over 80 years old.American journal of clinical and experimental urology · 2025
    Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Joseph A MiccioDepartment of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.
Wesley J TalcottDepartment of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.
Vikram JairamDepartment of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.
Henry S ParkDepartment of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.
James B YuDepartment of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.
Michael S LeapmanDepartment of Urology, Yale School of Medicine, New Haven, CT, USA.
Skyler B JohnsonHuntsman Cancer institute, University of Utah, Salt Lake City, UT, USA.
Martin T KingDepartment of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Paul L NguyenDepartment of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Benjamin H KannDepartment of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. Benjamin_Kann@DFCI.HARVARD.EDU.ORCID http://orcid.org/0000-0002-4313-2754

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundComparative effectiveness research (CER) using national registries influences cancer clinical trial design, treatment guidelines, and patient management. However, the extent to which treatment selection bias (TSB) affects overall survival (OS) in cancer CER remains poorly defined. We sought to quantify the TSB effect on OS in the setting of low-risk prostate cancer, where 10-year prostate cancer-specific survival (PCSS) approaches 100% regardless of treatment modality.

methodsThe Surveillance, Epidemiology, and End Results database was queried for patients with low-risk prostate cancer (cT1-T2a, PSA < 10, and Gleason 6) who received radical prostatectomy (RP), brachytherapy (BT), or external beam radiotherapy (EBRT) from 2005 to 2015. The TSB effect was defined as the unadjusted 10-year OS difference between modalities that was not due to differences in PCSS. Propensity score matching was used to estimate the TSB effect on OS due to measured confounders (variables present in the database and associated with OS) and unmeasured confounders.

resultsA total of 50,804 patients were included (8845 RP; 18,252 BT; 23,707 EBRT) with a median follow-up of 7.4 years. The 10-year PCSS for the entire cohort was 99%. The 10-year OS was 92.9% for RP, 83.6% for BT, and 76.9% for EBRT (p < 0.001). OS differences persisted after propensity score matching of RP vs. EBRT (7.4%), RP vs. BT (4.6%), and BT vs. EBRT (3.7%) (all p < 0.001). The TSB effect on 10-year OS was estimated to be 15.0% for RP vs. EBRT (8.6% measured, 6.4% unmeasured), 8.5% for RP vs. BT (4.8% measured, 3.7% unmeasured), and 6.5% for BT vs. EBRT (3.1% measured, 3.4% unmeasured).

conclusionsPatients with low-risk prostate cancer selected for RP exhibited large OS differences despite similar PCSS compared to radiotherapy, suggesting OS differences are almost entirely driven by TSB. The quantities of these effects are important to consider when interpreting prostate cancer CER using national registries.

Indexed as

AgedBrachytherapyCombined Modality TherapyComparative Effectiveness ResearchFollow-Up StudiesHumansMaleMiddle AgedPrognosisProstatectomyProstatic NeoplasmsRadiotherapy, Intensity-ModulatedSEER ProgramSelection BiasSurvival Rate

Identifiers

PMID32989262

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.