局限性前列腺癌治疗的地区差异：美国手术和放疗利用情况分析
Regional Differences in the Treatment of Localized Prostate Cancer: An Analysis of Surgery and Radiation Utilization in the United States.
作者信息
Scherzer Nickolas D, DiBiase Zachary S, Srivastav Sudesh K, Thomas Raju, DiBiase Steven J
机构信息
Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana.
Webb School of Knoxville, Knoxville, Tennessee.
出版信息
Adv Radiat Oncol. 2019 Jan 23;4(2):331-336. doi: 10.1016/j.adro.2019.01.004. eCollection 2019 Apr-Jun.
PURPOSE
Men with localized prostate cancer have various treatment options available in their management. The optimal approach is controversial and can be influenced by multiple factors. This study aimed to investigate the influence of geographic region on the selection of treatment for prostate cancer.
METHODS AND MATERIALS
Using the National Cancer Database, we identified men diagnosed with localized prostate cancer between 2010 and 2014. The United States was divided into 11 regions per the American Cancer Society Divisions. The first course of treatment was recorded as radiation therapy (RT), radical prostatectomy (RP), or active surveillance (AS). The RT subgroup consisted of patients receiving all forms of RT, including external beam and brachytherapy, or RT plus androgen deprivation therapy. The RP subgroup consisted of patients receiving RP alone or combined with RT or androgen deprivation therapy. A χ test was performed to assess the association between region and frequency of RT and RP.
RESULTS
This study included 462,811 men with localized prostate cancer who were treated in the United States, of whom 63.46% underwent RP, 31.54% underwent RT, and 5.00% underwent AS. Significant regional differences in RP and RT were observed ( ≤ .0001). RP was used most commonly in the Midwest (75.07%) and High Plains (73.37%) regions, whereas RP was least used in the South Atlantic (59.04%) region. Similarly, RT was used most commonly in South Atlantic (40.96%) and New England (38.98%) regions and least commonly in the Midwest (24.93%) region. AS was used most in the New England (7.27%) and Midwest (6.8%) regions and least used in the High Plains (2.57%) and Mid-South (2.84%) regions.
CONCLUSIONS
Regional differences exist in the United States with regard to the definitive treatment of localized prostate cancer. The etiology for these regional differences is likely multifactorial.
目的
局限性前列腺癌男性患者在治疗管理中有多种选择。最佳治疗方法存在争议，且会受到多种因素影响。本研究旨在调查地理区域对前列腺癌治疗选择的影响。
方法与材料
利用国家癌症数据库，我们确定了2010年至2014年间被诊断为局限性前列腺癌的男性患者。根据美国癌症协会分区，美国被划分为11个区域。首次治疗记录为放射治疗（RT）、根治性前列腺切除术（RP）或主动监测（AS）。RT亚组包括接受所有形式放疗的患者，包括外照射和近距离放疗，或放疗加雄激素剥夺治疗。RP亚组包括单独接受RP或联合放疗或雄激素剥夺治疗的患者。进行χ检验以评估区域与RT和RP频率之间的关联。
结果
本研究纳入了462,811名在美国接受治疗的局限性前列腺癌男性患者，其中63.46%接受了RP，31.54%接受了RT，5.00%接受了AS。观察到RP和RT存在显著的区域差异（≤.0001）。RP在中西部（75.07%）和高平原（73.37%）地区使用最为普遍，而在南大西洋（59.04%）地区使用最少。同样，RT在南大西洋（40.96%）和新英格兰（38.98%）地区使用最为普遍，在中西部（24.93%）地区使用最少。AS在新英格兰（7.27%）和中西部（6.8%）地区使用最多，在高平原（2.57%）和中南（2.84%）地区使用最少。
结论
在美国，局限性前列腺癌的确定性治疗存在区域差异。这些区域差异的病因可能是多因素的。
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