Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
Section of Urology, University of Chicago, Chicago, Illinois.
J Urol. 2015 Jan;193(1):95-102. doi: 10.1016/j.juro.2014.07.111. Epub 2014 Aug 5.
To our knowledge factors affecting the adoption of noncurative initial management in the United States for low risk prostate cancer on a population based level are unknown. We measured temporal trends in the proportion of patients with low and intermediate risk prostate cancer who elected noncurative initial treatment in the United States and analyzed the association of factors affecting management choice.
We identified 465,591 and 237,257 men diagnosed with low or intermediate risk prostate cancer using NCDB and SEER (2004 to 2010), respectively. We measured the proportion of men who elected noncurative initial treatment and used multivariate logistic regression analysis to evaluate factors affecting the treatment choice.
During the study period noncurative initial management increased in patients at low risk from 21% to 32% in SEER and from 13% to 20% in NCDB (each p < 0.001). This increase was not reflected in our overall study population (SEER 20% to 22% and NCDB 11% to 13%) since the proportion of patients with Gleason score 6 or less decreased with time (61% to 49% and 61% to 45%, respectively). From 2004 to 2010 older age, lower prostate specific antigen, earlier clinical stage, increased comorbidity index and not being married were associated with a higher likelihood of noncurative initial management (each p < 0.05).
Two independently managed, population based data sets confirmed a temporal increase in noncurative initial management in patients with low risk PCa that did not translate into greater use overall in those at low and intermediate risk combined. These contrasting results are likely due to grade migration resulting in fewer men being classified as with low risk PCa based on Gleason score.
据我们所知，在美国，基于人群水平，影响低危前列腺癌患者采用非治愈性初始治疗的因素尚不清楚。我们测量了美国低危和中危前列腺癌患者选择非治愈性初始治疗的比例随时间的变化趋势，并分析了影响管理选择的因素。
我们使用 NCDB 和 SEER（2004 年至 2010 年）分别确定了 465591 名和 237257 名低危或中危前列腺癌患者。我们测量了选择非治愈性初始治疗的男性比例，并使用多变量逻辑回归分析评估影响治疗选择的因素。
在研究期间，SEER 中低危患者的非治愈性初始管理比例从 21%增加到 32%，NCDB 中从 13%增加到 20%（均 p <0.001）。但我们的总体研究人群中并未反映出这种增加（SEER 为 20%至 22%，NCDB 为 11%至 13%），因为随着时间的推移，Gleason 评分 6 或更低的患者比例下降（分别为 61%至 49%和 61%至 45%）。2004 年至 2010 年，年龄较大、前列腺特异性抗原较低、较早的临床分期、合并症指数增加和未婚与非治愈性初始管理的可能性更高相关（均 p <0.05）。
两个独立管理的基于人群的数据集证实了低危 PCa 患者非治愈性初始治疗的时间增加，但在低危和中危合并患者中总体使用并未增加。这些对比结果可能是由于基于 Gleason 评分，低危 PCa 患者的数量减少导致分级迁移。
