Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Clin Genitourin Cancer. 2017 Oct;15(5):563-569.e3. doi: 10.1016/j.clgc.2016.10.011. Epub 2016 Oct 28.
We sought to determine whether any sociodemographic disparities are present in the receipt of local treatment for node-positive prostate cancer.
We identified 9771 patients with clinical N1M0 prostate cancer diagnosed from 1998 to 2012 using the National Cancer Database. We used multivariable logistic regression modeling to identify patient-specific factors that were associated with a reduced likelihood of receiving prostate or pelvic radiation or radical prostatectomy. We also used Cox regression modeling to estimate the differences in overall survival (OS) using these factors.
The factors associated with a reduced likelihood of receiving local therapy included black race versus white race (43.6% vs. 49.4%; adjusted odds ratio [AOR], 0.76; P = .001), bottom income quartile versus top quartile (44.7% vs. 52.7%; AOR, 0.69; P = .001), age > 66 years versus ≤ 66 years (40.8% vs. 55.1%; AOR, 0.48; P < .001), diagnosis before 2005 versus after 2005 (30.5% vs. 61.7%; AOR, 0.66; P < .001), and Medicaid or no insurance versus private insurance (41.0% vs. 49.4%; AOR, 0.41; P < .001). Although patients had reduced 5-year OS if they were from lower income quartiles (adjusted hazard ratios [AHRs], 1.18-1.22; P < .05), were older (AHR, 1.82; P < .001), or had Medicaid or no insurance (AHR, 1.24; P = .032), these disparities were no longer present or were smaller in magnitude after adjustment for receipt of local treatment.
Significant treatment disparities exist in the receipt of local therapy for node-positive prostate cancer. Given the accumulating evidence supporting this practice, the factors underlying these disparities should be studied and addressed.
我们试图确定在接受局部治疗的 N 阳性前列腺癌患者中是否存在社会人口统计学差异。
我们使用国家癌症数据库，从 1998 年至 2012 年，确定了 9771 名临床 N1M0 前列腺癌患者。我们使用多变量逻辑回归模型，确定与接受前列腺或盆腔放疗或根治性前列腺切除术可能性降低相关的患者特定因素。我们还使用 Cox 回归模型，根据这些因素估计总生存（OS）的差异。
与接受局部治疗可能性降低相关的因素包括黑种人种族而非白种人种族（43.6% vs. 49.4%；调整后优势比 [AOR]，0.76；P =.001），收入最低四分位数而非最高四分位数（44.7% vs. 52.7%；AOR，0.69；P =.001），年龄>66 岁而非≤66 岁（40.8% vs. 55.1%；AOR，0.48；P <.001），诊断于 2005 年之前而非之后（30.5% vs. 61.7%；AOR，0.66；P <.001），以及医疗补助或无保险而非私人保险（41.0% vs. 49.4%；AOR，0.41；P <.001）。尽管来自较低收入四分位数的患者的 5 年 OS 降低（调整后的危险比 [AHR]，1.18-1.22；P <.05），年龄较大（AHR，1.82；P <.001）或拥有医疗补助或无保险（AHR，1.24；P =.032），但这些差异在调整局部治疗后不再存在或程度较小。
在接受 N 阳性前列腺癌局部治疗方面存在显著的治疗差异。鉴于支持这种实践的累积证据，应研究和解决这些差异背后的因素。
