South Annabelle, Parulekar Wendy R, Sydes Matthew R, Chen Bingshu E, Parmar Mahesh K, Clarke Noel, Warde Padraig, Mason Malcolm
Medical Research Council Clinical Trials Unit, University College London, London, UK.
NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada.
Eur Urol Focus. 2016 Aug;2(3):276-283. doi: 10.1016/j.euf.2015.11.004.
Recent trials have shown that the addition of external beam radiotherapy (EBRT) to androgen deprivation therapy (ADT) improves survival among men with locally advanced prostate cancer.
To examine the potential impact of these trials on changes in clinical practice and life-years saved.
A model was developed to examine the impact of changes in clinical practice in the UK. A survey of clinicians who treat men with prostate cancer in the UK and Canada was performed.
Outcomes of interest were the proportion of patients treated with different approaches and the predicted number of life-years saved due to changes in clinical practice. Survey data were cross-tabulated and Pearson's χ tests were applied.
The survey was completed by 193 clinicians (105 from the UK, 80 from Canada), of whom 70% were clinical/radiation oncologists, 8% were medical oncologists, and 15% were urologists. UK respondents were more likely to report a change in practice in response to the results (44% UK vs 21% Canada). Canadians were more likely to have already been using ADT plus radiotherapy (77% Canada vs 56% UK). The increase in the proportion of patients in the UK treated with ADT + EBRT could result in around 3730-5177 extra life-years at 15 yr from a cohort of 7930 men diagnosed in a single calendar year, compared to if all had been treated with ADT alone.
Trial findings have changed clinical practice, meaning that men with locally advanced prostate cancer are likely to survive longer.
Doctors in the UK have changed practice in response to evidence on the superiority of hormone therapy plus radiotherapy to hormone therapy alone. These changes will improve the survival of men with locally advanced prostate cancer. Further reductions in the use of hormone therapy alone could further improve survival.
近期试验表明，在雄激素剥夺治疗（ADT）基础上加用外照射放疗（EBRT）可提高局部晚期前列腺癌男性患者的生存率。
探讨这些试验对临床实践变化及挽救生命年数的潜在影响。
设计、地点与参与者：建立一个模型来研究英国临床实践变化的影响。对英国和加拿大治疗前列腺癌男性患者的临床医生进行了一项调查。
感兴趣的结果是采用不同治疗方法的患者比例以及因临床实践变化预测挽救的生命年数。对调查数据进行交叉制表并应用Pearson卡方检验。
193名临床医生（105名来自英国，80名来自加拿大）完成了调查，其中70%为临床/放射肿瘤学家，8%为医学肿瘤学家，15%为泌尿科医生。英国受访者更有可能报告因研究结果而改变临床实践（英国为44%，加拿大为21%）。加拿大人更有可能已经在使用ADT联合放疗（加拿大为77%，英国为56%）。与所有患者均仅接受ADT治疗相比，在英国接受ADT + EBRT治疗的患者比例增加，可能使在单一日历年内确诊的7930名男性患者队列在15年后多挽救约3730 - 5177个生命年。
试验结果改变了临床实践，这意味着局部晚期前列腺癌男性患者可能存活更长时间。
英国医生已根据激素治疗加放疗优于单纯激素治疗的证据改变了临床实践。这些改变将提高局部晚期前列腺癌男性患者的生存率。进一步减少单纯激素治疗的使用可能进一步提高生存率。
