Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Walter Reed National Military Medical Center, Bethesda, MD, USA.
Prostate Cancer Prostatic Dis. 2023 Jun;26(2):271-275. doi: 10.1038/s41391-021-00467-5. Epub 2021 Nov 3.
We assessed the concordance among urologists' judgment of health quartiles for patients with localized prostate cancer, and compared the life expectancy (LE) and ensuing treatment recommendations when following National Comprehensive Cancer Network (NCCN) guidelines based on actuarial life tables versus the Kent model, a validated LE prediction model.
NCCN suggests using actuarial life tables and relying on surgeon assessment of patient health to increase (for the best quartile) or decrease (for the worst quartile) LE by 50%. Eleven urologic surgeons allocated quartile of health and recommended treatments for ten patient vignettes. The 10-year survival probability was calculated using the Kent model and compared to the life-table estimate based on health quartile by surgeon consensus.
Surgeon assessment agreed with the presumed true quartile of health based on a validated model in 41% of cases. For no case did three-quarters of surgeons assign health quartile correctly; in half of cases, <50% of surgeons assigned the correct quartile. The NCCN comorbidity-adjusted LE estimates underestimated risk of death in the best health quartile and overestimated risk of death in the worst health quartile, compared to the Kent model. Patients with LE > 10 years on NCCN estimation were recommended more frequently for surgery (81%) and those with ≤10 years estimated LE were more commonly recommended for radiation (57%) or observation (29%).
A method based on physician-assessed health quartiles for LE estimation, as suggested by the NCCN guidelines, appears too crude to be used in the treatment counseling of men with localized prostate cancer, as compared to a validated prediction model, such as the Kent model.
我们评估了泌尿科医生对局限性前列腺癌患者健康四分位的判断的一致性，并比较了根据国家综合癌症网络 (NCCN) 指南使用 actuarial life tables 和 Kent 模型（一种经过验证的寿命预测模型）计算的预期寿命 (LE) 和随后的治疗建议。
NCCN 建议使用 actuarial life tables，并依靠外科医生对患者健康的评估，通过增加（最佳四分位）或减少（最差四分位）LE 来增加或减少 50%。11 名泌尿科医生为十个患者病例分配健康四分位并推荐治疗方法。使用 Kent 模型计算 10 年生存率，并将其与基于外科医生共识的健康四分位的寿命表估计进行比较。
在 41%的病例中，外科医生的评估与基于经过验证的模型的假定真实健康四分位一致。在没有一个病例中，四分之三的外科医生正确分配健康四分位；在一半的病例中，<50%的外科医生分配了正确的四分位。与 Kent 模型相比，NCCN 合并症调整后的 LE 估计低估了最佳健康四分位的死亡风险，高估了最差健康四分位的死亡风险。NCCN 估计 LE>10 年的患者更常被推荐接受手术治疗（81%），而 LE≤10 年的患者更常被推荐接受放疗（57%）或观察（29%）。
与经过验证的预测模型（如 Kent 模型）相比，NCCN 指南中建议的基于医生评估的健康四分位来估计 LE 的方法似乎过于粗糙，无法用于局限性前列腺癌患者的治疗咨询。
