Department for Radiation Oncology, Martin-Luther University Halle-Wittenberg, Halle, Germany.
OnkoZert, Independent Certification Institute of the German Cancer Society, Neu-Ulm, Germany.
J Cancer Res Clin Oncol. 2020 May;146(5):1197-1204. doi: 10.1007/s00432-020-03140-x. Epub 2020 Mar 4.
To assess the association of public health parameters with the regional variation in the initial treatment for prostate cancer.
We used data from German epidemiologic cancer registries for the years 2009-2013. Presence of a certified cancer center, a radiotherapy and/or urology institution, the district-specific GDP, and population density were used as predictors. Patients with indication for adjuvant treatment were excluded (T3b). Only districts with defined quality criteria were eligible. We used general linear mixed models (equivalent to logistic regression) with a covariance matrix weighted by the Euclidean distances between districts. Models were adjusted for age, grading, and TNM stage. We performed sensitivity analyses by imputing missing data with multiple imputation and considering extreme case scenarios. We applied inverse probability weighting to account for missing values.
When radiotherapy/surgery is compared to neither treatment, the probability for the latter was higher in East than in West Germany (OR 1.7, 95% CI 1.43-2.02). The same was true for districts with both, a radiotherapy and urologic treatment facility (OR 1.43, 1.19-1.72). Analyzing radiotherapy vs. surgery, the probability for prostatectomy was inversely associated with the presence of a radiotherapy unit when compared to districts with neither treatment facility (OR 0.52, 95% CI 0.38-0.73). Patients treated in East Germany were more likely to receive a surgical treatment (OR 1.34, 95% CI 1.08-1.66). Sensitivity analyses revealed no relevant change of effect estimates.
Treatment differs between East and West Germany and is associated with the presence of a radiotherapy or urology clinic.
评估公共卫生参数与前列腺癌初始治疗区域差异的关系。
我们使用了 2009-2013 年德国流行病学癌症登记处的数据。使用有认证的癌症中心、放疗和/或泌尿科机构、特定地区的国内生产总值和人口密度作为预测因子。排除有辅助治疗指征的患者（T3b）。只有符合质量标准的地区才有资格。我们使用一般线性混合模型（相当于逻辑回归），其协方差矩阵由地区之间的欧几里得距离加权。模型调整了年龄、分级和 TNM 分期。我们通过使用多重插补和考虑极端情况进行敏感性分析来处理缺失数据。我们应用逆概率加权来处理缺失值。
当放疗/手术与两种治疗方法相比时，东部地区比西部地区选择后两种治疗方法的概率更高（OR 1.7，95%CI 1.43-2.02）。对于同时具有放疗和泌尿科治疗设施的地区也是如此（OR 1.43，1.19-1.72）。分析放疗与手术时，与没有治疗设施的地区相比，当存在放疗单位时，前列腺切除术的概率呈反比（OR 0.52，95%CI 0.38-0.73）。在东德接受治疗的患者更有可能接受手术治疗（OR 1.34，95%CI 1.08-1.66）。敏感性分析显示，效果估计值没有明显变化。
东德和西德的治疗方法存在差异，与放疗或泌尿科诊所的存在有关。
