辨别接受根治性前列腺切除术或放疗的前列腺癌患者的生存优势：癌症登记数据的局限性。
Discerning the survival advantage among patients with prostate cancer who undergo radical prostatectomy or radiotherapy: The limitations of cancer registry data.
作者信息
Williams Stephen B, Huo Jinhai, Chamie Karim, Smaldone Marc C, Kosarek Christopher D, Fang Justin E, Ynalvez Leslie A, Kim Simon P, Hoffman Karen E, Giordano Sharon H, Chapin Brian F
机构信息
Division of Urology, The University of Texas Medical Branch, Galveston, Texas.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
出版信息
Cancer. 2017 May 1;123(9):1617-1624. doi: 10.1002/cncr.30506. Epub 2017 Jan 18.
BACKGROUND
The objective of this study was to compare the overall survival of patients who undergo radical prostatectomy or radiotherapy versus noncancer controls to discern whether there is a survival advantage according to prostate cancer treatment and the impact of selection bias on these results.
METHODS
A matched cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. In total, 34,473 patients ages 66 to 75 years were identified who were without significant comorbidity, were diagnosed with localized prostate cancer, and received treatment treated with surgery or radiotherapy between 2004 and 2011. These patients were matched to a noncancer control cohort. The rates of all-cause mortality that occurred within the study period were compared. Cox proportional hazards regression analysis was used to identify determinants associated with overall survival.
RESULTS
Of 34,473 patients who were included in the analysis, 21,740 (63%) received radiation therapy, and 12,733 (37%) underwent surgery. There was improved survival in patients who underwent surgery (hazard ratio, 0.35; 95% confidence interval, 0.32-0.38) and in those who received radiotherapy (hazard ratio, 0.72; 95% confidence interval, 0.68-0.75) compared with noncancer controls. Overall survival improved significantly in both treatment groups, with the greatest benefit observed among patients who underwent surgery (log rank P < .001).
CONCLUSIONS
Population-based data indicated that patients with prostate cancer who received treatment with either surgery or radiotherapy had improved overall survival compared with a cohort of matched noncancer controls. Surgery produce longer survival compared with radiation therapy. These results suggest an inherent selection-bias because of unmeasured confounding variables. Cancer 2017;123:1617-1624. © 2017 American Cancer Society.
背景
本研究的目的是比较接受根治性前列腺切除术或放射治疗的患者与非癌症对照者的总生存率，以确定前列腺癌治疗是否存在生存优势以及选择偏倚对这些结果的影响。
方法
使用监测、流行病学和最终结果（SEER）与医疗保险关联数据库进行了一项匹配队列研究。总共确定了34473名年龄在66至75岁之间、无明显合并症、被诊断为局限性前列腺癌且在2004年至2011年期间接受手术或放射治疗的患者。这些患者与一个非癌症对照队列进行匹配。比较了研究期间发生的全因死亡率。采用Cox比例风险回归分析来确定与总生存相关的决定因素。
结果
在纳入分析的34473名患者中，21740名（63%）接受了放射治疗，12733名（37%）接受了手术。与非癌症对照者相比，接受手术的患者（风险比，0.35；95%置信区间，0.32 - 0.38）和接受放射治疗的患者（风险比，0.72；95%置信区间，0.68 - 0.75）的生存率有所提高。两个治疗组的总生存率均显著提高，在接受手术的患者中观察到的获益最大（对数秩检验P <.001）。
结论
基于人群的数据表明，与匹配的非癌症对照队列相比，接受手术或放射治疗的前列腺癌患者的总生存率有所提高。手术比放射治疗产生更长的生存期。这些结果提示由于未测量的混杂变量存在内在的选择偏倚。《癌症》2017年；123:（1617 - 1624）。©2017美国癌症协会。
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