泌尿外科医生和放射肿瘤学家在局限性前列腺癌管理方面的实践模式差异：一项横断面调查。

Differences in practice patterns between urologists and radiation oncologists in the management of localized prostate cancer: a cross-sectional survey.

作者信息

Ariane Mehdi Mokhtar, Ploussard Guillaume, Rebillard Xavier, Malavaud Bernard, Rischmann Pascal, Hennequin Christophe, Mongiat-Artus Pierre

机构信息

Division of Urology, Academic Hospital Saint-Louis, University Paris VII, Paris, France.

Division of Urology, Clinic Beau Soleil, Montpellier, France.

出版信息

World J Urol. 2015 Nov;33(11):1741-7. doi: 10.1007/s00345-015-1543-2. Epub 2015 Mar 31.

DOI:10.1007/s00345-015-1543-2

PMID:25822706

Abstract

INTRODUCTION

Through a cross-sectional survey, we tried to assess whether practices of urologists and radiation oncologists are uniform when faced with similar clinical situations.

MATERIALS AND METHODS

A self-administered questionnaire was mailed to all French urologists and radiation oncologists. Respondents were asked about their practices through 11 case scenarios. The scenarios cover most of localized prostate cancer situations and were gradually organized depending on prostate cancer progression risk and the age of the patient. The eight first scenarios address the situation of treatment-naive patients, and the last cases were about the management of patients after radical prostatectomy. Physicians were asked to choose a treatment modality for each case. The responses were first stratified according to the intention to treat: either curative-intent treatment or palliative. The curative-treatment modality chosen were afterward assessed. The responses to clinical scenarios were compared between the two specialties.

RESULTS

Concerning the intention to treat, practice patterns were overall consistent except in one case. Indeed, a higher rate of radiation oncologists prefer curative-intent treatment for intermediate-risk prostate cancer in aged patients: 57.4 versus 14.6 % (p < 0.001). Each medical specialist prefers the treatment that he himself delivers (p < 0.005). For intermediate-risk prostate cancer in 65-year-old patient: 96.5 % of urologists chose radical prostatectomy versus 37.7 % of radiation oncologists (p < 0.001). Fewer urologists (almost 14 %) compared to radiation oncologists (47.5 %) would prescribe adjuvant treatment after radical prostatectomy for T3a R0 prostate cancer with post-operative PSA undetectable (p < 0.001).

CONCLUSION

Significant differences were found in therapeutic approach between the two main specialties that deal with localized prostate cancer.

摘要

引言

通过一项横断面调查，我们试图评估泌尿外科医生和放射肿瘤学家在面对相似临床情况时的做法是否一致。

材料与方法

向所有法国泌尿外科医生和放射肿瘤学家邮寄了一份自填式问卷。通过11个病例场景询问受访者的做法。这些场景涵盖了大多数局限性前列腺癌情况，并根据前列腺癌进展风险和患者年龄逐步组织。前八个场景涉及未经治疗患者的情况，最后几个病例是关于根治性前列腺切除术后患者的管理。要求医生为每个病例选择一种治疗方式。首先根据治疗意图对回答进行分层：即根治性治疗意图或姑息性治疗。随后评估所选择的根治性治疗方式。比较两个专业对临床场景的回答。

结果

关于治疗意图，除了一个病例外，实践模式总体上是一致的。确实，放射肿瘤学家中更倾向于对老年患者的中危前列腺癌进行根治性治疗的比例更高：57.4% 对14.6%（p < 0.001）。每个医学专科医生都更喜欢自己所提供的治疗（p < 0.005）。对于65岁患者的中危前列腺癌：96.5%的泌尿外科医生选择根治性前列腺切除术，而放射肿瘤学家为37.7%（p < 0.001）。与放射肿瘤学家（47.5%）相比，较少的泌尿外科医生（近14%）会对术后PSA不可检测的T3a R0前列腺癌在根治性前列腺切除术后开辅助治疗药物（p < 0.001）。