Filson Christopher P, Shelton Jeremy B, Tan Hung-Jui, Kwan Lorna, Skolarus Ted A, Saigal Christopher S, Litwin Mark S
Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Veterans Affairs Atlanta Healthcare System, Decatur, Georgia.
Cancer. 2016 Feb 15;122(4):626-33. doi: 10.1002/cncr.29785. Epub 2015 Nov 5.
For certain men with low-risk prostate cancer, aggressive treatment results in marginal survival benefits while exposing them to urinary and sexual side effects. Nevertheless, expectant management has been underused. In the current study, the authors evaluated the association between various factors and expectant management use among veterans diagnosed with prostate cancer.
The authors identified men diagnosed with prostate cancer in 2008. The outcome of interest was use of expectant management, based on documentation captured through an in-depth chart review. Multivariable regression models were fit to examine associations between use of expectant management and patient demographics, cancer severity, and facility characteristics. The authors assessed variation across 21 tertiary care regions and 52 facilities by generating predicted probabilities for receipt of expectant management.
Expectant management was more common among patients aged ≥75 years (40% vs 27% for those aged < 55 years; odds ratio, 2.57) and those with low-risk tumors (49% vs 20% for patients with high-risk tumors; odds ratio, 5.35). There was no association noted between patient comorbidity and receipt of expectant management (P = .90). There were also no associations found between facility factors and use of expectant management (all P>.05). Among ideal candidates for expectant management, receipt of expectant management varied considerably across individual facilities (0%-85%; P<.001).
Patient age and tumor risk were found to be more strongly associated with use of expectant management than patient comorbidity. Although use of expectant management appears broadly appropriate, there was variation in expectant management noted between hospitals that was apparently not attributable to facility factors. Research determining the basis of this variation, with a focus on providers, will be critical to help optimize prostate cancer treatment for veterans.
对于某些低风险前列腺癌男性患者，积极治疗带来的生存获益微乎其微，却会使他们面临泌尿和性功能方面的副作用。然而，观察等待治疗一直未得到充分利用。在本研究中，作者评估了各种因素与被诊断为前列腺癌的退伍军人接受观察等待治疗之间的关联。
作者确定了2008年被诊断为前列腺癌的男性患者。基于通过深入病历审查获取的记录，感兴趣的结果是观察等待治疗的使用情况。采用多变量回归模型来检验观察等待治疗的使用与患者人口统计学特征、癌症严重程度及医疗机构特征之间的关联。作者通过生成接受观察等待治疗的预测概率，评估了21个三级医疗区域和52家医疗机构之间的差异。
观察等待治疗在年龄≥75岁的患者中更为常见（40%，而年龄＜55岁的患者为27%；比值比为2.57）以及肿瘤风险低的患者中（高危肿瘤患者为20%，低危肿瘤患者为49%；比值比为5.35）。未发现患者合并症与接受观察等待治疗之间存在关联（P = 0.90）。也未发现医疗机构因素与观察等待治疗的使用之间存在关联（所有P＞0.05）。在观察等待治疗的理想候选患者中，各个医疗机构接受观察等待治疗的情况差异很大（0% - 85%；P＜0.001）。
发现患者年龄和肿瘤风险与观察等待治疗的使用之间的关联比患者合并症更强。尽管观察等待治疗的使用总体上似乎是合适的，但各医院之间观察等待治疗的使用情况存在差异，而这种差异显然并非由医疗机构因素导致。以提供者为重点，确定这种差异基础的研究对于帮助优化退伍军人前列腺癌治疗至关重要。
