Sinha Sumi, Muralidhar Vinayak, Feng Felix Y, Nguyen Paul L
Harvard Medical School, Boston, MA 02115, USA.
Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA 02115, USA.
Prostate Int. 2017 Sep;5(3):89-94. doi: 10.1016/j.prnil.2017.04.003. Epub 2017 Apr 18.
We sought to determine temporal trends in the receipt of prostatectomy or locoregional radiation to the prostate for patients with metastatic prostate cancer and to identify predictors of receipt of local treatment.
We identified 39,976 patients with metastatic prostate cancer diagnosed in 2004-2012 using the National Cancer Database (NCDB). We used logistic multivariable regression to determine trends in the receipt of prostate and/or pelvic radiation or radical prostatectomy after adjusting for demographic and clinical factors.
Patients with metastatic disease were less likely to receive locoregional treatment over time [7.88% in 2004 vs. 5.53% in 2012, adjusted odds ratio (AOR) = 0.97 per year, 95% confidence interval (CI) = 0.95-0.98; < 0.001]. Cofactors associated with decreased likelihood for locoregional treatment included older age (AOR = 0.96 per year, 95% CI = 0.96-0.96, < 0.001) and increased comorbidity level (1 comorbidity: AOR = 0.82, 95% CI = 0.73-0.93, = 0.001; two or more comorbidities: AOR = 0.49, 95% CI = 0.39-0.61, < 0.001). Decreasing utilization of both radiation and surgery of the primary site contributed to this trend. More specifically, patients with metastatic disease were less likely to receive radiation to the prostate and/or pelvis over time (5.9% in 2004 vs. 4.2% in 2012, AOR = 0.97 per year, 95% CI = 0.95-0.99, < 0.001). Similarly, there was a trend toward decreased use of radical prostatectomy (2.17% in 2004 compared to 1.31% in 2012, AOR = 0.96 per year, 95% CI 0.93-0.99, = 0.01).
Despite recent evidence of the possible benefit for locoregional treatment of prostate cancer in the setting of metastatic disease, rates of prostate radiation and radical prostatectomy among this population have actually declined over the 8-year period between 2004 and 2012, suggesting slow adoption of this novel treatment paradigm.
我们试图确定转移性前列腺癌患者接受前列腺切除术或前列腺局部区域放疗的时间趋势，并找出接受局部治疗的预测因素。
我们使用国家癌症数据库（NCDB）确定了2004年至2012年期间诊断出的39976例转移性前列腺癌患者。我们使用逻辑多变量回归来确定在调整人口统计学和临床因素后接受前列腺和/或盆腔放疗或根治性前列腺切除术的趋势。
随着时间的推移，转移性疾病患者接受局部区域治疗的可能性降低[2004年为7.88%，2012年为5.53%，调整后的优势比（AOR）=每年0.97，95%置信区间（CI）=0.95 - 0.98；P < 0.001]。与局部区域治疗可能性降低相关的因素包括年龄较大（AOR =每年0.96，95% CI = 0.96 - 0.96，P < 0.001）和合并症水平增加（1种合并症：AOR = 0.82，95% CI = 0.73 - 0.93，P = 0.001；两种或更多种合并症：AOR = 0.49，95% CI = 0.39 - 0.61，P < 0.001）。原发部位放疗和手术的利用率下降导致了这一趋势。更具体地说，随着时间的推移，转移性疾病患者接受前列腺和/或盆腔放疗的可能性降低（2004年为5.9%，2012年为4.2%，AOR =每年0.97，95% CI = 0.95 - 0.99，P < 0.001）。同样，根治性前列腺切除术的使用也有下降趋势（2004年为2.17%，2012年为1.31%，AOR =每年0.96，95% CI 0.93 - 0.99，P = 0.01）。
尽管最近有证据表明在转移性疾病背景下局部区域治疗前列腺癌可能有益，但在2004年至2012年的8年期间，该人群中前列腺放疗和根治性前列腺切除术的发生率实际上有所下降，这表明这种新的治疗模式采用缓慢。
