Löppenberg Björn, Sood Akshay, Dalela Deepansh, Karabon Patrick, Sammon Jesse D, Vetterlein Malte W, Noldus Joachim, Peabody James O, Trinh Quoc-Dien, Menon Mani, Abdollah Firas
Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI.
Clin Genitourin Cancer. 2017 Dec;15(6):e955-e968. doi: 10.1016/j.clgc.2017.04.014. Epub 2017 Apr 26.
Contemporary treatment trends for prostate cancer show increased rates of active surveillance. However, nationwide applicability of these reports is limited. Additionally, the effect of Commission on Cancer facility type on prostate cancer treatment patterns is unknown.
We used the National Cancer Data Base to identify men diagnosed with prostate cancer, between 2004 and 2013. Our cohort was stratified on the basis of the National Comprehensive Cancer Network prostate cancer risk classes. Cochran-Armitage tests were used to evaluate temporal trends. Random effects hierarchical logit models were used to assess treatment variation at Commission on Cancer facility and institution level.
In 825,707 men, utilization of radiation therapy declined and utilization of radical prostatectomy increased for all prostate cancer risk groups between 2004 and 2013 (P < .0001). Observation for low-risk prostate cancer increased from 16.3% in 2004 to 2005 to 32.0% in 2012 to 2013 (P < .0001). Significant treatment variation was observed on the basis of Commission on Cancer facility type. Across all risk groups, the lowest rates of radical prostatectomy and highest rates of external beam radiation therapy were observed in community cancer programs. The highest rates of observation for low-risk disease were observed in academic centers. Treatment variation according to institution ranged from 14% (95% confidence interval, 0.12-0.15) for androgen deprivation therapy up to 59% (95% confidence interval, 0.45-0.73) for cryotherapy.
The increased utilization of observation in low-risk prostate cancer is an encouraging finding, which appears to be mainly derived by a decrease in radiotherapy utilization in this risk group. Regardless of tumor characteristics, significant variations in treatment modality exist among different facility types and institutions.
当代前列腺癌的治疗趋势显示，主动监测的比例有所增加。然而，这些报告在全国范围内的适用性有限。此外，癌症委员会设施类型对前列腺癌治疗模式的影响尚不清楚。
我们使用国家癌症数据库来识别2004年至2013年间被诊断为前列腺癌的男性。我们的队列根据国家综合癌症网络前列腺癌风险类别进行分层。采用 Cochr an - Armitage检验来评估时间趋势。使用随机效应分层逻辑模型来评估癌症委员会设施和机构层面的治疗差异。
在825707名男性中，2004年至2013年间，所有前列腺癌风险组的放射治疗使用率下降，根治性前列腺切除术的使用率上升（P <.0001）。低风险前列腺癌的观察率从2004年至2005年的16.3%增加到2012年至2013年的32.0%（P <.0001）。根据癌症委员会设施类型观察到显著的治疗差异。在所有风险组中，社区癌症项目中根治性前列腺切除术的发生率最低，外照射放疗的发生率最高。学术中心对低风险疾病的观察率最高。根据机构不同，治疗差异范围从雄激素剥夺治疗的14%（95%置信区间，0.12 - 0.15）到冷冻治疗的59%（95%置信区间，0.45 - 0.73）。
低风险前列腺癌观察率的增加是一个令人鼓舞的发现，这似乎主要源于该风险组放射治疗使用率的下降。无论肿瘤特征如何，不同设施类型和机构之间的治疗方式存在显著差异。
