UCLA Department of Urology, Health Services Research Group, 924 Westwood Blvd., Suite 1000, Los Angeles, California 90024, USA.
J Gen Intern Med. 2012 May;27(5):492-9. doi: 10.1007/s11606-011-1869-4. Epub 2011 Sep 21.
Comorbidity is poorly integrated into prostate cancer decision making.
We sought to characterize treatment type and subsequent survival for men with no more than a single comorbid condition.
We conducted a retrospective study of 1,031 veterans with non-metastatic prostate cancer diagnosed in 1997-2004 at the Greater Los Angeles and Long Beach Veterans Affairs Medical Centers and followed until 2010. We used multivariate analyses to determine probabilities and relative risks of undergoing treatment for each health state and competing-risks regression analyses to model non-prostate cancer mortality.
Compared with subjects without any comorbid conditions, only men with moderate-severe chronic obstructive pulmonary disease were less likely to receive definitive treatment for their prostate cancer (RR 0.74; 95% CI 0.44-0.99). Men with all other individual comorbidities were equally likely as men without comorbidity to receive definitive treatment. Compared with men without any comorbidities, a higher hazard rate for non-prostate cancer mortality was identified among men with diabetes without end-organ damage (HR 2.32; 95% CI 1.32-4.08), peripheral vascular disease (HR 2.77; 95% CI 1.14-6.73), moderate-severe chronic obstructive pulmonary disease (HR 5.46; 95% CI 2.68-11.12), diabetes with end-organ damage (HR 4.27; 95% CI 1.64-11.10), those in need of a mobility device (HR 3.29; 95% CI 1.87-5.80), and men with history of alcoholism (HR 1.77; 95% CI 1.07-2.93).
Men with comorbid conditions and health states that portend poor prognoses are nonetheless aggressively treated for their prostate cancer. Advancing age modulates this effect.
合并症在前列腺癌决策中未得到充分考虑。
我们旨在描述仅有单一合并症的男性的治疗类型和随后的生存情况。
我们对 1997 年至 2004 年间在大洛杉矶和长滩退伍军人事务医疗中心诊断为非转移性前列腺癌的 1031 名退伍军人进行了回顾性研究，并随访至 2010 年。我们使用多变量分析确定每种健康状况下接受治疗的概率和相对风险，并使用竞争风险回归分析来模拟非前列腺癌死亡率。
与没有任何合并症的患者相比，仅有中重度慢性阻塞性肺疾病的患者接受前列腺癌确定性治疗的可能性较低（RR 0.74；95%CI 0.44-0.99）。患有其他任何一种合并症的患者与没有合并症的患者接受确定性治疗的可能性相同。与没有任何合并症的患者相比，患有糖尿病但无终末器官损害（HR 2.32；95%CI 1.32-4.08）、外周血管疾病（HR 2.77；95%CI 1.14-6.73）、中重度慢性阻塞性肺疾病（HR 5.46；95%CI 2.68-11.12）、糖尿病伴终末器官损害（HR 4.27；95%CI 1.64-11.10）、需要移动设备（HR 3.29；95%CI 1.87-5.80）和有酗酒史（HR 1.77；95%CI 1.07-2.93）的患者，非前列腺癌死亡率的风险更高。
患有合并症和预示预后不良的健康状况的男性仍积极接受前列腺癌治疗。年龄的增长调节了这种影响。
