Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Finnish Cancer Registry, Helsinki, Finland.
Eur J Cancer. 2020 May;130:204-210. doi: 10.1016/j.ejca.2020.02.045. Epub 2020 Mar 28.
In prostate cancer (PCa), lower education level is associated with less screening, more advanced stage at diagnosis and worse survival. The aim of this study was to estimate the association between education level and treatment modality and subsequently survival.
The 9255 men diagnosed with PCa in the Finnish Randomized Study of Screening for Prostate Cancer were included. Cancer stage, comorbidity, education level and primary treatment modality were extracted from the patient records, the Finnish Cancer Registry, Statistics Finland and the National Institute of Health and Welfare, and these covariates were used in logistic regression (treatment selection) and Cox regression (survival analysis).
In high-risk cancers, men with tertiary education were more likely to be treated with radical prostatectomy (odds ratio [OR] = 1.76; 95% confidence interval [CI] = 1.27-2.44) than men with primary education. Men with secondary (OR = 0.57; 95% CI = 0.38-0.84) or tertiary (OR = 0.42; 95% CI = 0.29-0.60) education were managed less frequently with mere hormonal therapy. In locally advanced cases, tertiary education was associated with more curatively aimed therapies and less hormonal therapy (OR for radical prostatectomy = 2.34; 95% CI = 1.49-3.66; OR for radiotherapy = 1.42; 95% CI = 1.09-1.85; OR for hormonal therapy = 0.45; 95% CI = 0.33-0.60). The hazard ratio for PCa death was lower in men with secondary (0.81; 95% CI = 0.69-0.95) and tertiary (0.75; 95% CI = 0.65-0.87) education than in the patients with primary education.
When controlled for the cancer risk group, comorbidity and patient's age, low education level is independently associated with less curatively aimed treatment in men with high-risk or locally advanced PCa and subsequently worse prognosis.
在前列腺癌（PCa）中，较低的受教育程度与筛查率较低、诊断时更晚期和生存率较差有关。本研究的目的是评估教育程度与治疗方式之间的关系，并随后评估生存率。
纳入了在芬兰前列腺癌筛查随机研究中诊断为 PCa 的 9255 名男性患者。从患者记录、芬兰癌症登记处、芬兰统计局和国家卫生福利研究所提取癌症分期、合并症、教育程度和主要治疗方式，并将这些协变量用于逻辑回归（治疗选择）和 Cox 回归（生存分析）。
在高危癌症中，接受过高等教育的男性接受根治性前列腺切除术的可能性高于接受过初级教育的男性（优势比[OR] = 1.76；95%置信区间[CI] = 1.27-2.44）。接受过中等教育（OR = 0.57；95%CI = 0.38-0.84）或高等教育（OR = 0.42；95%CI = 0.29-0.60）的男性较少接受单纯激素治疗。在局部晚期病例中，高等教育与更多的根治性治疗和较少的激素治疗相关（根治性前列腺切除术的 OR = 2.34；95%CI = 1.49-3.66；放疗的 OR = 1.42；95%CI = 1.09-1.85；激素治疗的 OR = 0.45；95%CI = 0.33-0.60）。与接受初级教育的患者相比，接受中等教育（0.81；95%CI = 0.69-0.95）和高等教育（0.75；95%CI = 0.65-0.87）的男性患 PCa 死亡的风险比更低。
在控制癌症风险组、合并症和患者年龄后，低教育程度与高危或局部晚期 PCa 男性接受较少的根治性治疗相关，随后预后较差。
