Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
Prostate Cancer Prostatic Dis. 2023 Jun;26(2):257-263. doi: 10.1038/s41391-021-00439-9. Epub 2021 Sep 7.
Many factors are implicated in the potential 'under-treatment' of prostate cancer but little is known about the between-hospital variation.
The National Prostate Cancer Audit (NPCA) database was used to identify high-risk localised or locally advanced prostate cancer patients in England, between January 2014 and December 2017, and the treatments received. Hospital-level variation in radical local treatment was explored visually using funnel plots. The intra-class correlation coefficient (ICC) quantified the between-hospital variation in a random-intercept multivariable logistic regression model.
53,888 men, from 128 hospitals, were included and 35,034 (65.0%) received radical local treatment. The likelihood of receiving radical local treatment was increased in men who were younger (the strongest predictor), more affluent, those with fewer comorbidities, and in those with a non-Black ethnic background. There was more between-hospital variation (P < 0.001) for patients aged ≥80 years (ICC: 0.235) compared to patients aged 75-79 years (ICC: 0.070), 70-74 years (ICC: 0.041), and <70 years (ICC: 0.048). Comorbidity and socioeconomic deprivation did not influence the between-hospital variation.
Radical local treatment of high-risk localised or locally advanced prostate cancer depended strongly on age and comorbidity, but also on socioeconomic deprivation and ethnicity, with the between-hospital variation being highest in older patients.
许多因素与前列腺癌的潜在“治疗不足”有关，但对医院间的差异知之甚少。
利用国家前列腺癌审计（NPCA）数据库，于 2014 年 1 月至 2017 年 12 月期间，在英格兰确定了高危局限性或局部进展性前列腺癌患者，并记录了他们所接受的治疗。通过漏斗图直观地探讨了根治性局部治疗的医院间差异。随机截距多变量逻辑回归模型中的组内相关系数（ICC）量化了医院间的差异。
共纳入了 128 家医院的 53888 名男性患者，其中 35034 名（65.0%）接受了根治性局部治疗。在年龄较小（最强预测因素）、较富裕、合并症较少以及非黑人背景的男性中，接受根治性局部治疗的可能性更高。对于年龄≥80 岁的患者（ICC：0.235），与年龄为 75-79 岁（ICC：0.070）、70-74 岁（ICC：0.041）和<70 岁（ICC：0.048）的患者相比，医院间的差异更大（P<0.001）。合并症和社会经济剥夺对医院间的差异没有影响。
高危局限性或局部进展性前列腺癌的根治性局部治疗强烈取决于年龄和合并症，但也取决于社会经济剥夺和种族，在老年患者中，医院间的差异最大。
