Leapman Michael S, Wang Rong, Park Henry S, Yu James B, Weinreb Jeffrey C, Gross Cary P, Ma Xiaomei
Department of Urology, Yale School of Medicine, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT.
Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
Urology. 2019 Feb;124:98-106. doi: 10.1016/j.urology.2018.07.041. Epub 2018 Aug 11.
To evaluate the association between prostate magnetic resonance imaging (MRI) and the use of observation for men with low-risk prostate cancer (PCa).
We used the Surveillance, Epidemiology, and End Results-Medicare database to identify men diagnosed with low-risk PCa during 2010-2013. We assessed the use of prostate MRI and management using claims in period surrounding PCa diagnosis. The relation of clinical and demographic factors to receipt of MRI was evaluated with multivariable logistic regression analysis. Following propensity score matching, we fit conditional logistic regression models to examine the association between prostate MRI and initial management, ie, observation or definitive treatment.
Of 8144 patients with low-risk PCa, 495 (6.1%) received MRI. Use of MRI increased from 3.4% in 2010 to 10.5% in 2013. A total of 3060 (37.6%) patients received observation. MRI was performed in 265 (8.7%) of patients receiving observation, and 230 (4.5%) who were treated (P < .0001). In multivariable analysis, measures of socioeconomic status were significantly associated with the use of prostate MRI. Following propensity score matching, receipt of prostate MRI surrounding the diagnosis of PCa was associated with a significantly higher likelihood of observation (odds ratio = 1.90, 95% confidence interval: 1.56-2.32). This effect persisted in sensitivity analyses attempting to exclude treatment-planning MRIs.
Receipt of prostate MRI surrounding PCa diagnosis was associated with a nearly 2-fold greater odds of receiving observation vs definitive treatment.
评估前列腺磁共振成像（MRI）与低风险前列腺癌（PCa）男性患者观察等待治疗方式之间的关联。
我们使用监测、流行病学和最终结果-医疗保险数据库，以识别在2010 - 2013年期间被诊断为低风险PCa的男性患者。我们通过PCa诊断前后期间的理赔数据评估前列腺MRI的使用情况和治疗管理方式。采用多变量逻辑回归分析评估临床和人口统计学因素与MRI检查接受情况之间的关系。在倾向得分匹配之后，我们拟合条件逻辑回归模型，以研究前列腺MRI与初始治疗管理方式（即观察等待或确定性治疗）之间的关联。
在8144例低风险PCa患者中，495例（6.1%）接受了MRI检查。MRI检查的使用率从2010年的3.4%增至2013年的10.5%。共有3060例（37.6%）患者接受了观察等待治疗。在接受观察等待治疗的患者中，265例（8.7%）进行了MRI检查，而在接受确定性治疗的患者中，这一比例为230例（4.5%）（P < .0001）。在多变量分析中，社会经济地位指标与前列腺MRI的使用显著相关。在倾向得分匹配之后，PCa诊断前后接受前列腺MRI检查与观察等待治疗的可能性显著更高相关（优势比 = 1.90，95%置信区间：1.56 - 2.32）。在试图排除治疗计划MRI的敏感性分析中，这一效应仍然存在。
PCa诊断前后接受前列腺MRI检查与接受观察等待治疗而非确定性治疗的可能性高出近2倍相关。
