Dall'era Marc A, Hosang Nap, Konety Badrinath, Cowan Janet E, Carroll Peter R
Urologic Outcomes Research Group, Department of Urology, University of California-San Francisco, San Francisco, California, USA.
J Urol. 2009 Apr;181(4):1622-7; discussion 1627. doi: 10.1016/j.juro.2008.11.123. Epub 2009 Feb 23.
We determined various sociodemographic predictors of prostate cancer risk category at presentation as assessed by serum prostate specific antigen, cancer grade and tumor stage.
We performed a retrospective cohort study of 5,939 patients enrolled in the CaPSURE national disease registry database between 1995 and 2007. Prostate cancer risk category was assigned as low, intermediate or high based on diagnostic prostate specific antigen, clinical grade and biopsy Gleason grade. Additionally, a group of men with low grade, limited volume tumors were identified as having clinically insignificant disease. The primary outcome was prostate cancer risk category at presentation. Treatment received vs active surveillance was analyzed as a secondary end point.
Patients who were older, had lower levels of education and had Medicare with or without a supplement instead of private or Veteran's Affairs insurance were more likely to have intermediate and high risk disease than low risk disease. Nonwhite race was associated with high risk disease at presentation. Clinically insignificant disease was more common in men younger than 60 years, those with higher education and income, and those with private insurance. Logistic regression analysis suggested that younger age, higher education and income, and private insurance were related to insignificant disease being detected. Among men with insignificant disease younger age and private insurance were associated with immediate treatment with curative intent.
Unique sociodemographic variables are associated with the clinical risk of prostate cancer at diagnosis and they may influence treatment decisions and outcomes. Patients with insignificant disease may be susceptible to overtreatment due to the indolent nature of the disease. Intermediate and high risk groups, which are associated with poorer outcomes, may be further endangered by late detection of the disease.
我们确定了初诊时前列腺癌风险类别（通过血清前列腺特异性抗原、癌症分级和肿瘤分期评估）的各种社会人口统计学预测因素。
我们对1995年至2007年间纳入CaPSURE国家疾病登记数据库的5939例患者进行了一项回顾性队列研究。根据诊断时的前列腺特异性抗原、临床分级和活检Gleason分级，将前列腺癌风险类别分为低、中或高。此外，一组低级别、小体积肿瘤的男性被确定为患有临床意义不显著的疾病。主要结局是初诊时的前列腺癌风险类别。将接受的治疗与主动监测作为次要终点进行分析。
年龄较大、教育程度较低且拥有医疗保险（无论有无补充保险）而非私人保险或退伍军人事务保险的患者，相较于低风险疾病，更有可能患有中高风险疾病。非白人种族在初诊时与高风险疾病相关。临床意义不显著的疾病在60岁以下、教育程度和收入较高以及拥有私人保险的男性中更为常见。逻辑回归分析表明，年龄较小、教育程度和收入较高以及私人保险与检测到临床意义不显著的疾病有关。在患有临床意义不显著疾病的男性中，年龄较小和私人保险与根治性即刻治疗相关。
独特的社会人口统计学变量与前列腺癌诊断时的临床风险相关，它们可能影响治疗决策和结果。由于疾病进展缓慢，临床意义不显著疾病的患者可能易受过度治疗影响。与较差结局相关的中高风险组可能因疾病发现较晚而进一步面临风险。
