Maurice Matthew J, Zhu Hui, Abouassaly Robert
University Hospitals Case Medical Center, Cleveland, OH.
Louis Stokes Cleveland VA Medical Center and Cleveland Clinic South Pointe Hospital, Cleveland, OH.
Can Urol Assoc J. 2015 Mar-Apr;9(3-4):E193-9. doi: 10.5489/cuaj.2606. Epub 2015 Apr 13.
Initial observation (IO) is a strategy to minimize prostate cancer overtreatment. We sought to evaluate contemporary trends in IO utilization for low-risk prostate cancer in the United States and to identify factors associated with its uptake.
Using the National Cancer Database, we identified men with low-risk prostate cancer diagnosed between 2004 and 2011. IO utilization was plotted over time. Multivariate logistic regression was performed to determine the influence of diagnosis year and other factors on IO selection.
Of the 219 971 men with low-risk prostate cancer, 21 231 (9.7%) underwent IO. Beginning in 2008, IO use increased significantly with time (range: 7.5%-14.3%). Compared to 2004, patients diagnosed in 2011 had 2.5 times the odds of choosing IO (odds ratio [OR] 2.5, confidence interval [CI] 2.3-2.6, p < 0.01). Aside from diagnosis year, age, race, Charlson score, clinical T stage, and PSA level predicted IO use (p < 0.01). Other predictors of IO included hospital type, insurance provider, and household income. Specifically, comprehensive cancer centres, private insurance, and higher income predicted decreased IO usage (OR 0.5, CI 0.5-0.5, p < 0.01; OR 0.4, CI 0.4-0.4, p < 0.01; and OR 0.8, CI 0.8-0.9, p < 0.01, respectively). Less educated men were also less likely to undergo observation (OR 0.8, CI 0.8-0.9, p < 0.01). Treatment within the western United States was significantly, but weakly, associated with increased use of IO (p < 0.01).
In recent years, low-risk prostate cancer has been increasingly managed with IO, appropriately driven by patient and disease factors. Unexpectedly, observation usage also varies by race, hospital, insurance, income, and geography, suggesting that non-clinical factors may affect treatment selection.
初始观察（IO）是一种将前列腺癌过度治疗降至最低的策略。我们试图评估美国低风险前列腺癌IO利用的当代趋势，并确定与其采用相关的因素。
利用国家癌症数据库，我们确定了2004年至2011年期间被诊断为低风险前列腺癌的男性。IO利用率随时间进行了绘制。进行多因素逻辑回归以确定诊断年份和其他因素对IO选择的影响。
在219971名低风险前列腺癌男性中，21231名（9.7%）接受了IO。从2008年开始，IO的使用随时间显著增加（范围：7.5%-14.3%）。与2004年相比，2011年诊断的患者选择IO的几率是其2.5倍（优势比[OR]2.5，置信区间[CI]2.3-2.6，p<0.01）。除诊断年份外，年龄、种族、查尔森评分、临床T分期和PSA水平可预测IO的使用（p<0.01）。IO的其他预测因素包括医院类型、保险提供商和家庭收入。具体而言，综合癌症中心、私人保险和较高收入预测IO使用减少（OR 0.5，CI 0.5-0.5，p<0.01；OR 0.4，CI 0.4-0.4，p<0.01；OR 0.8，CI 0.8-0.9，p<0.01，分别）。受教育程度较低的男性接受观察的可能性也较小（OR 0.8，CI 0.8-0.9，p<0.01）。美国西部的治疗与IO使用增加显著但微弱相关（p<0.01）。
近年来，低风险前列腺癌越来越多地通过IO进行管理，这是由患者和疾病因素适当驱动的。出乎意料的是，观察的使用也因种族、医院、保险、收入和地理位置而异，这表明非临床因素可能影响治疗选择。
