Mahmood Usama, Pugh Thomas, Frank Steven, Levy Lawrence, Walker Gary, Haque Waqar, Koshy Matthew, Graber William, Swanson David, Hoffman Karen, Kuban Deborah, Lee Andrew
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
Brachytherapy. 2014 Mar-Apr;13(2):157-62. doi: 10.1016/j.brachy.2013.08.005. Epub 2013 Sep 17.
To analyze the recent trends in the utilization of external beam radiation therapy (EBRT) and brachytherapy (BT) for the treatment of prostate cancer.
Using the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all patients diagnosed with localized prostate adenocarcinoma between 2004 and 2009 who were treated with radiation as local therapy. We evaluated the utilization of BT, EBRT, and combination BT+EBRT by the year of diagnosis and performed a multivariable analysis to determine the predictors of BT as treatment choice.
Between 2004 and 2009, EBRT monotherapy use increased from 55.8% to 62.0%, whereas all BT use correspondingly decreased from 44.2% to 38.0% (BT-only use decreased from 30.4% to 25.6%, whereas BT+EBRT use decreased from 13.8% to 12.3%). The decline of BT utilization differed by patient race, SEER registry, median county income, and National Comprehensive Cancer Network risk categorization (all p<0.001), but not by patient age (p=0.763) or marital status (p=0.193). Multivariable analysis found that age, race, marital status, SEER registry, median county income, and National Comprehensive Cancer Network risk category were independent predictors of BT as treatment choice (all p<0.001). Moreover, after controlling for all available patient and tumor characteristics, there was decreasing utilization of BT with increasing year of diagnosis (odds ratio for BT=0.920, 95% confidence interval: 0.911-0.929, p<0.001).
Our analysis reveals decreasing utilization of BT for prostate cancer. This finding has significant implications in terms of national health care expenditure.
分析外照射放疗（EBRT）和近距离放疗（BT）在前列腺癌治疗中的应用近期趋势。
利用监测、流行病学和最终结果（SEER）数据库，获取了2004年至2009年间所有被诊断为局限性前列腺腺癌且接受放疗作为局部治疗的患者的信息。我们按诊断年份评估了BT、EBRT以及BT+EBRT联合治疗的应用情况，并进行多变量分析以确定选择BT治疗的预测因素。
2004年至2009年间，EBRT单药治疗的使用率从55.8%增至62.0%，而所有BT治疗的使用率相应地从44.2%降至38.0%（单纯BT治疗的使用率从30.4%降至25.6%，而BT+EBRT联合治疗的使用率从13.8%降至12.3%）。BT应用的下降因患者种族、SEER登记处、县收入中位数以及美国国立综合癌症网络风险分类而异（均p<0.001），但不因患者年龄（p=0.763）或婚姻状况（p=0.193）而异。多变量分析发现，年龄、种族、婚姻状况、SEER登记处、县收入中位数以及美国国立综合癌症网络风险类别是选择BT治疗的独立预测因素（均p<0.001）。此外，在控制了所有可用的患者和肿瘤特征后，随着诊断年份的增加，BT的应用率呈下降趋势（BT的优势比=0.920，95%置信区间：0.911 - 0.929，p<0.001）。
我们的分析显示前列腺癌BT治疗的应用率在下降。这一发现对国家医疗保健支出具有重要意义。
