Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.
Eur Urol. 2016 Sep;70(3):429-35. doi: 10.1016/j.eururo.2016.02.057. Epub 2016 Mar 4.
The National Comprehensive Cancer Network and the European Association of Urology guidelines recommend using radiation therapy (RT) with androgen deprivation therapy (ADT) to treat high-risk and locally advanced prostate cancer patients.
To evaluate the degree of adherence to these guidelines.
DESIGN, SETTING, AND PARTICIPANTS: Between 2003 and 2009, in the Surveillance Epidemiology and End Results (SEER)-Medicare database, 14 180 patients were diagnosed with high-risk (T1-T2 with World Health Organization histologic grade 3) or locally advanced (T3-T4 with any histologic grade) prostatic adenocarcinoma.
Administration of RT-ADT versus RT alone.
We assessed the rate of adherence to guidelines with respect to use of RT-ADT in the overall population and after stratification according to stage-grade groupings (T1-T2 G3 vs T3-T4 any grade), age (66-69, 70-74, 75-79, ≥80 yr), Charlson Comorbidity Index (CCI) (0, 1, ≥2), and preexisting baseline cardiovascular (CV) disease. We depicted the rate of RT-ADT administration graphically over the study period. Multivariable logistic regression analyses were performed to assess the predictors of RT-ADT use.
RT-ADT rates and guideline adherence were 58-75%, with the highest rate (75%) in 2003 and the lowest (58%) in 2009. When stratified according to stage-grade groupings, age, CCI, and preexisting baseline CV disease, similar results were obtained. In multivariable analyses, year of diagnosis (p<0.001), patient age (p<0.001), stage-grade groupings (p<0.001), CCI (p=0.036), race (p<0.001), marital status (p<0.001), population density (p<0.001), and US regions (p<0.001) were independent predictors of RT-ADT use. The limitations of our study include age >65 yr and exclusive Medicare coverage.
The rate of guideline adherence regarding the use of RT-ADT is suboptimal and decreases with time instead of increasing.
This population-based study provides evidence of low adherence to international urologic guidelines regarding the combination of radiation therapy (RT) with androgen deprivation therapy (ADT) for high-risk and locally advanced prostate cancer (PCa) patients. Despite the increasing number of randomized controlled trials over time that showed a survival benefit for patients with high-risk and locally advanced PCa treated with RT-ADT compared with RT alone, the rate of adherence to guidelines decreased with time.
美国国家综合癌症网络和欧洲泌尿外科学会指南建议使用放射治疗（RT）联合雄激素剥夺疗法（ADT）治疗高危和局部晚期前列腺癌患者。
评估对这些指南的遵循程度。
设计、地点和参与者：在 2003 年至 2009 年间，在监测、流行病学和最终结果（SEER）-医疗保险数据库中，有 14180 名患者被诊断为高危（T1-T2 期，世界卫生组织组织学分级 3 级）或局部晚期（T3-T4 期，任何组织学分级）前列腺腺癌。
接受 RT-ADT 治疗与单独接受 RT 治疗。
我们评估了根据分期-分级分组（T1-T2 G3 与 T3-T4 任何分级）、年龄（66-69、70-74、75-79、≥80 岁）、Charlson 合并症指数（CCI）（0、1、≥2）和基线前心血管疾病（CV）情况，使用 RT-ADT 的指南遵循率。我们以图表形式描述了研究期间 RT-ADT 给药的比率。进行多变量逻辑回归分析以评估 RT-ADT 使用的预测因素。
RT-ADT 率和指南遵循率为 58%-75%，2003 年最高（75%），2009 年最低（58%）。按分期-分级分组、年龄、CCI 和基线前 CV 疾病分层后，得到了相似的结果。在多变量分析中，诊断年份（p<0.001）、患者年龄（p<0.001）、分期-分级分组（p<0.001）、CCI（p=0.036）、种族（p<0.001）、婚姻状况（p<0.001）、人口密度（p<0.001）和美国地区（p<0.001）是 RT-ADT 使用的独立预测因素。我们研究的局限性包括年龄>65 岁和仅接受医疗保险覆盖。
关于高危和局部晚期前列腺癌患者使用 RT-ADT 的指南遵循率不理想，而且随着时间的推移而降低，而不是增加。
这项基于人群的研究提供了证据，表明国际泌尿科指南关于高危和局部晚期前列腺癌（PCa）患者使用放射治疗（RT）联合雄激素剥夺疗法（ADT）的建议遵循率较低。尽管随着时间的推移，越来越多的随机对照试验表明，高危和局部晚期 PCa 患者接受 RT-ADT 治疗比单独接受 RT 治疗有生存获益，但指南的遵循率却随着时间的推移而降低。
