Mohan Ravinder, Beydoun Hind, Davis John, Lance Raymond, Schellhammer Paul
Department of Family and Community Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Can J Urol. 2010 Feb;17(1):4975-84.
Treatment for localized prostate cancer (LPC) may not improve survival and commonly impairs health related quality of life. National guidelines provide algorithms to choose between treatment or observation for LPC, but the algorithms require the factoring of the patient's baseline comorbidity adjusted life expectancy (CALE). However, no method is available to estimate CALE of 10 or more years.
A mailed survey was completed by newly diagnosed untreated LPC patients. Their baseline CALE was estimated by weighting their age based life expectancy by quartiles of comorbidity scores, and a national guideline was used to find if treatment or observation was recommended for each patient. Demographic, health and cancer characteristics, and beliefs were compared in patients who chose treatment or observation concordant with the guideline, and those who chose under treatment or over treatment.
Of 184 survey participants, 10 chose under treatment, 144 chose concordant treatment, and 30 chose over treatment. Under treatment patients had similar sociodemographic and health characteristics to patients who were concordant. In comparison to concordant patients, over treatment patients were older, had a lower Gleason grade or PSA level, a higher comorbidity score, a lower CALE, and lower scores on the Fear of Cancer Recurrence scale.
Comorbidity scores can be used to estimate CALE in LPC patients, and estimation of CALE allows the use of guidelines in the choice of treatment. In our study, over treatment occurred more frequently than under treatment. Factors known to limit the survival benefit of treatment were associated with over treatment. Over treatment patients also had lower fear of cancer recurrence.
局部前列腺癌（LPC）的治疗可能无法提高生存率，且通常会损害健康相关生活质量。国家指南提供了在LPC治疗或观察之间进行选择的算法，但这些算法需要考虑患者的基线合并症调整预期寿命（CALE）。然而，目前尚无方法可估算10年或更长时间的CALE。
对新诊断未治疗的LPC患者进行了邮寄调查。通过根据合并症评分四分位数对其基于年龄的预期寿命进行加权来估算他们的基线CALE，并使用国家指南来确定每位患者是推荐治疗还是观察。比较了根据指南选择治疗或观察的患者以及选择治疗不足或过度治疗的患者的人口统计学、健康和癌症特征及信念。
在184名调查参与者中，10人选择治疗不足，144人选择符合指南的治疗，30人选择过度治疗。治疗不足的患者与符合指南的患者具有相似的社会人口统计学和健康特征。与符合指南的患者相比，过度治疗的患者年龄更大，Gleason分级或PSA水平更低，合并症评分更高，CALE更低，且在癌症复发恐惧量表上的得分更低。
合并症评分可用于估算LPC患者的CALE，而CALE的估算有助于在治疗选择中使用指南。在我们的研究中，过度治疗比治疗不足更频繁发生。已知限制治疗生存获益的因素与过度治疗相关。过度治疗的患者对癌症复发的恐惧也更低。
