Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Int J Radiat Oncol Biol Phys. 2019 Apr 1;103(5):1053-1057. doi: 10.1016/j.ijrobp.2018.08.001. Epub 2018 Aug 9.
Retrospective analyses of cancer registry and institutional data have consistently found better survival after radical prostatectomy versus radiation therapy, which contrasts with findings from a randomized trial. This is likely because of the inability of retrospective studies to fully account for comorbidity differences across treatment groups because of the lack of detailed data in the registries. We use a unique population-based data set with detailed data regarding comorbidities and functional limitations to assess whether this can provide valid comparisons of survival across prostate cancer treatment groups.
The Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) data set results from a linkage between the SEER database and the MHOS database, which includes detailed information regarding patient-reported comorbidity and functional limitations. We analyzed 3102 patients with prostate cancer in SEER-MHOS and used latent class analysis to identify the healthiest group with minimal comorbidity burden and functional limitations. Among the healthiest group, we examined overall survival across treatments using the Kaplan-Meier method.
Three distinct health groups were identified using latent class analysis; the healthiest group comprised 57% of the cohort and had a 10-year overall survival of 67%. Other health groups had higher rates of comorbidities or functional limitations. Among the healthiest group, 10-year overall survival differed across treatment groups: no local treatment (55%), external beam radiation therapy (69%), brachytherapy (76%), and radical prostatectomy (85%). Survival curves for the 3 treated groups separated at 4 years of follow-up.
Despite the detailed health status information available in SEER-MHOS, our retrospective analysis could not fully account for patient selection biases across prostate cancer treatment groups. These findings highlight an important limitation of retrospective studies using population-based data sets and serve as a reminder to interpret results with caution.
癌症登记处和机构数据的回顾性分析一致发现根治性前列腺切除术比放射治疗的生存预后更好，这与随机试验的结果形成对比。这很可能是因为回顾性研究由于登记处缺乏详细数据，无法充分考虑治疗组之间的合并症差异。我们使用独特的基于人群的数据集，其中包含有关合并症和功能限制的详细数据，以评估这是否可以为前列腺癌治疗组的生存提供有效的比较。
SEER-MHOS 数据集是 SEER 数据库和 MHOS 数据库之间链接的结果，其中包含有关患者报告的合并症和功能限制的详细信息。我们分析了 SEER-MHOS 中的 3102 例前列腺癌患者，并使用潜在类别分析来确定合并症负担和功能限制最小的最健康组。在最健康的组中，我们使用 Kaplan-Meier 方法检查了各种治疗方法的总体生存率。
使用潜在类别分析确定了三个不同的健康组；最健康的组占队列的 57%，10 年总体生存率为 67%。其他健康组具有更高的合并症或功能限制率。在最健康的组中，10 年总体生存率因治疗组而异：无局部治疗（55%）、外照射放疗（69%）、近距离放疗（76%）和根治性前列腺切除术（85%）。治疗组的生存曲线在 4 年随访时开始分离。
尽管 SEER-MHOS 中提供了详细的健康状况信息，但我们的回顾性分析仍无法完全说明前列腺癌治疗组之间的患者选择偏差。这些发现突出了使用基于人群的数据集进行回顾性分析的一个重要局限性，并提醒人们谨慎解释结果。
