Department of Urology, University of Arizona College of Medicine, 1501 N. Campbell Avenue, PO Box 245077, Tucson, AZ, 85724-5077, USA.
Int Urol Nephrol. 2020 Sep;52(9):1611-1615. doi: 10.1007/s11255-020-02463-5. Epub 2020 Apr 13.
To evaluate recent trends in the management of low-risk prostate cancer (PCa) and analyze differences in adoption of surveillance based on state Medicaid-expansion status in the United States (US).
Using the National Cancer Database, we identified men diagnosed from 2012 to 2016. Men with histologically confirmed low-risk PCa defined as PSA less than 10 ng/ml, Gleason score ≤ 6, and cT1-T2a were included. The Cochran Armitage test was used to evaluate trends in surveillance versus treatment. Comparisons on surveillance adoption based on 2014 Medicaid expansion status and difference-in-difference analysis were performed.
The cohort included 84,340 men. During the study period, surveillance as initial management increased from 13.6% in 2012 to 32.1% in 2016 (p < 0.01). When comparing by Medicaid-expansion status, expansion states had higher rates in adoption of surveillance as compared to non-expansion states over the study period (36.6 vs 28.5%). Following expansion, men in expansion states were 1.94% more likely to be treated with surveillance than in earlier years (p < 0.01). Men in non-expansion states were 1.97% more likely to receive surveillance following expansion (p < 0.01) for a relative 0.03% difference in active surveillance adoption among men with low-risk PCa (95% CI - 0.004 to 0.013, p = 0.344).
Based on the data from 2012 to 2016, there has been a significant increase in active surveillance as initial management for low-risk PCa in the US. Medicaid expansion was not found to be detrimental in adoption of surveillance. Understanding the impact of payer status on health outcomes can aid in the development of future health care policies aiming to mitigate disparities.
评估美国低危前列腺癌（PCa）管理的近期趋势，并分析各州医疗补助计划扩张状态对监测采用的差异。
利用国家癌症数据库，我们鉴定了 2012 年至 2016 年间诊断为 PCa 的男性。入组患者为组织学证实的低危 PCa 患者，定义为 PSA ＜10ng/ml、Gleason 评分≤6 和 cT1-T2a。采用 Cochran-Armitage 检验评估监测与治疗的趋势。基于 2014 年医疗补助计划扩张状态进行监测采用的比较和差异分析。
该队列包括 84340 名男性。研究期间，初始管理中监测的比例从 2012 年的 13.6%增加到 2016 年的 32.1%（p＜0.01）。按医疗补助计划扩张状态进行比较，扩张州在研究期间采用监测的比例高于非扩张州（36.6%比 28.5%）。扩张后，与早年相比，扩张州的男性接受监测治疗的可能性高 1.94%（p＜0.01）。扩张后，非扩张州的男性接受监测的可能性高 1.97%（p＜0.01），低危 PCa 男性的主动监测采用率相对差异为 0.03%（95%CI -0.004 至 0.013，p=0.344）。
基于 2012 年至 2016 年的数据，美国低危 PCa 中主动监测作为初始治疗的比例显著增加。未发现医疗补助计划扩张对监测的采用产生不利影响。了解支付者状态对健康结果的影响有助于制定未来旨在减少差异的医疗保健政策。
