Yang David D, Muralidhar Vinayak, Mahal Brandon A, Labe Shelby A, Nezolosky Michelle D, Vastola Marie E, King Martin T, Martin Neil E, Orio Peter F, Choueiri Toni K, Trinh Quoc-Dien, Spratt Daniel E, Hoffman Karen E, Feng Felix Y, Nguyen Paul L
Harvard Medical School, Boston, Massachusetts.
Department of Medicine, Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2017 Jun 1;98(2):338-343. doi: 10.1016/j.ijrobp.2017.02.020. Epub 2017 Feb 21.
Androgen deprivation therapy (ADT) is not recommended for low-risk prostate cancer because of its lack of benefit and potential for harm. We evaluated the incidence and predictors of ADT use in low-risk disease.
Using the National Cancer Database, we identified 197,957 patients with low-risk prostate cancer (Gleason score of 3 + 3 = 6, prostate-specific antigen level <10 ng/mL, and cT1-T2a) diagnosed from 2004 to 2012 with complete demographic and treatment information. We used multiple logistic regression to evaluate predictors of ADT use and Cox regression to examine its association with all-cause mortality.
Overall ADT use decreased from 17.6% in 2004 to 3.5% in 2012. In 2012, 11.5% of low-risk brachytherapy patients and 7.6% of external beam radiation therapy patients received ADT. Among 82,352 irradiation-managed patients, predictors of ADT use included treatment in a community versus academic cancer program (adjusted odds ratio [AOR], 1.60; 95% confidence interval [CI], 1.50-1.71; P<.001; incidence, 14.0% vs 6.0% in 2012); treatment in the South (AOR, 1.51), Midwest (AOR, 1.81), or Northeast (AOR, 1.90) versus West (P<.001); and brachytherapy use versus external beam radiation therapy (AOR, 1.32; 95% CI, 1.27-1.37; P<.001). Among 25,196 patients who did not receive local therapy, predictors of primary ADT use included a Charlson-Deyo comorbidity score of ≥2 versus 0 (AOR, 1.42; 95% CI, 1.06-1.91; P=.018); treatment in a community versus academic cancer program (AOR, 1.61; 95% CI, 1.37-1.90; P<.001); and treatment in the South (AOR, 1.26), Midwest (AOR, 1.52), or Northeast (AOR, 1.28) versus West (P≤.008). Primary ADT use was associated with increased all-cause mortality in patients who did not receive local therapy (adjusted hazard ratio, 1.28; 95% CI, 1.14-1.43; P<.001) after adjustment for age and comorbidity.
ADT use in low-risk prostate cancer has declined nationally but may remain an issue of concern in certain populations and regions.
由于雄激素剥夺疗法（ADT）缺乏益处且存在潜在危害，故不推荐用于低风险前列腺癌。我们评估了低风险疾病中ADT的使用发生率及预测因素。
利用国家癌症数据库，我们确定了197957例低风险前列腺癌患者（Gleason评分为3 + 3 = 6，前列腺特异性抗原水平<10 ng/mL，且cT1 - T2a），这些患者于2004年至2012年被诊断，具备完整的人口统计学和治疗信息。我们使用多因素逻辑回归来评估ADT使用的预测因素，并使用Cox回归来检验其与全因死亡率的关联。
总体ADT使用率从2004年的17.6%降至2012年的3.5%。2012年，11.5%的低风险近距离放射治疗患者和7.6%的外照射放疗患者接受了ADT。在82352例接受放疗的患者中，ADT使用的预测因素包括在社区癌症项目而非学术癌症项目中接受治疗（调整后的优势比[AOR]，1.60；95%置信区间[CI]，1.50 - 1.71；P <.001；2012年发生率分别为14.0%和6.0%）；在南部（AOR，1.51）、中西部（AOR，1.81）或东北部（AOR，1.90）接受治疗而非西部（P <.001）；以及使用近距离放射治疗而非外照射放疗（AOR，1.32；95% CI，1.27 - 1.37；P <.001）。在25196例未接受局部治疗的患者中，初次使用ADT的预测因素包括Charlson - Deyo合并症评分≥2而非0（AOR，1.42；95% CI，1.06 - 1.91；P =.018）；在社区癌症项目而非学术癌症项目中接受治疗（AOR，1.61；95% CI，1.37 - 1.90；P <.001）；以及在南部（AOR，1.26）、中西部（AOR，1.52）或东北部（AOR，1.28）接受治疗而非西部（P≤.008）。在调整年龄和合并症后，未接受局部治疗的患者中初次使用ADT与全因死亡率增加相关（调整后的风险比，1.28；95% CI，1.14 - 1.43；P <.001）。
低风险前列腺癌中ADT的使用在全国范围内有所下降，但在某些人群和地区可能仍是一个值得关注的问题。
