PhD Student, Tampere School of Public Health, University of Tampere, Tampere, Finland.
Health Expect. 2014 Dec;17(6):776-83. doi: 10.1111/j.1369-7625.2012.00802.x. Epub 2012 Jul 19.
Patient preference for the choice of treatment modality for prostate cancer has increasingly gained attention.
To assess the impact of client-oriented decision on long-term mortality, disease progression and biochemical failure compared with standard treatment protocol (TP).
With data from a Finnish multicentre, randomized controlled trial with two arms [104 in the enhanced patient participation (EPP) arm and 106 in the TP arm], disease-specific and disease-free survival, biochemical failure with elevated prostate-specific antigen (PSA) level and disease progression were compared between the two arms using Wilcoxon test and also Cox proportional hazards regression model.
Patients in the EPP arm had a higher risk of death by 37% [HR, 1.37 (0.87-2.17)] compared with those in the TP arm. Patients in the EPP arm were at increased risk of having biochemical failure by 14% [HR, 1.14 (0.72-1.79)] and for having disease progression by 2% [HR, 1.02 (0.61-1.70)] compared with those in the TP arm. All the differences were non-significant.
Patients actively involved in the choice of treatment had higher risk of prostate cancer death but only slightly increased risk of biochemical failure and clinical disease progression. These findings would provide a good reference when patient autonomy for the choice of treatment modality is addressed.
患者对前列腺癌治疗方式的选择偏好越来越受到关注。
评估与标准治疗方案（TP）相比，以患者为中心的决策对长期死亡率、疾病进展和生化失败的影响。
利用来自芬兰多中心、随机对照试验的两组数据[增强患者参与（EPP）组 104 例，TP 组 106 例]，采用 Wilcoxon 检验和 Cox 比例风险回归模型比较两组之间疾病特异性和无病生存率、前列腺特异性抗原（PSA）水平升高的生化失败和疾病进展。
与 TP 组相比，EPP 组患者的死亡风险高出 37%[风险比（HR），1.37（0.87-2.17）]。与 TP 组相比，EPP 组患者发生生化失败的风险增加了 14%[HR，1.14（0.72-1.79）]，发生疾病进展的风险增加了 2%[HR，1.02（0.61-1.70）]。所有差异均无统计学意义。
积极参与治疗选择的患者患前列腺癌死亡的风险更高，但生化失败和临床疾病进展的风险仅略有增加。当涉及到患者对治疗方式的自主选择时，这些发现将提供很好的参考。
