Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Cancer Med. 2023 Apr;12(8):9868-9878. doi: 10.1002/cam4.5650. Epub 2023 Feb 2.
Active surveillance/watchful waiting (AS/WW) is feasible and effective for favorable-risk prostate cancer (PCa). Understanding socioeconomic determinants of AS/WW may help determine the target population for social support and improve cancer-related survival.
The Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting Database 18 Registries identified 229,428 adult men diagnosed with primary localized PCa (clinical T1-T2c, N0M0) during a median follow-up of 45 months between 2010 and 2016. Socioeconomic determinants included socioeconomic status (SES) tertiles, marital status (unmarried vs married), and residency (urban vs rural). Multivariable logistic regression and Cox models determined the adjusted odds ratios (aOR) for AS/WW utilization, and adjusted hazard ratio (aHR) for cancer-specific survival (CSS) and overall survival (OS). The extent of missing data was evaluated by multiple imputation. Sensitivity analyses were performed in multiple imputation datasets.
Unmarried patients were more likely to receive AS/WW in low-risk group (aOR, 1.20 [95%CI, 1.12-1.28]; p < 0.001) and favorable intermediate-risk group (aOR, 1.41 [95%CI, 1.26-1.59]; p < 0.001) than married patients. Urban patients had 0.77-fold lower likelihood of AS/WW than rural patients in low-risk group (95% CI, 0.68-0.87; p < 0.001), but not in favorable intermediate-risk groups. Among patients undertaking AS/WW, a significantly worse OS was observed among unmarried patients comparing to married group (aHR, 1.98 [95% CI, 1.50-2.60]; p < 0.001), and patients with high SES had better CSS than low group (aHR, 0.08 [95%CI, 0.01-0.69]; p = 0.02). No significant survival difference was found between urban and rural patients.
Unmarried or urban patients had significantly higher rates of AS/WW. The utilization and efficacy of conservative management were affected by socioeconomic factors, which might serve as a barrier of treatment decision-making and targeted a population in need of social support.
主动监测/观察等待（AS/WW）对于低危前列腺癌（PCa）是可行且有效的。了解社会经济决定因素可能有助于确定需要社会支持的目标人群，并改善与癌症相关的生存。
监测、流行病学和最终结果前列腺观察等待数据库 18 个登记处确定了 229428 名成年男性，他们在 2010 年至 2016 年期间中位随访 45 个月期间被诊断为原发性局限性 PCa（临床 T1-T2c，N0M0）。社会经济决定因素包括社会经济地位（SES）三分位数、婚姻状况（未婚与已婚）和居住地点（城市与农村）。多变量逻辑回归和 Cox 模型确定了 AS/WW 利用的调整后优势比（aOR），以及癌症特异性生存（CSS）和总生存（OS）的调整后危险比（aHR）。通过多重插补评估缺失数据的程度。在多重插补数据集进行敏感性分析。
与已婚患者相比，低危组（aOR，1.20[95%CI，1.12-1.28]；p<0.001）和中危组（aOR，1.41[95%CI，1.26-1.59]；p<0.001）中未婚患者更有可能接受 AS/WW。低危组中，城市患者接受 AS/WW 的可能性比农村患者低 0.77 倍（95%CI，0.68-0.87；p<0.001），但在中危组中并非如此。在接受 AS/WW 的患者中，与已婚组相比，未婚患者的 OS 明显更差（aHR，1.98[95%CI，1.50-2.60]；p<0.001），而 SES 较高的患者 CSS 好于 SES 较低的患者（aHR，0.08[95%CI，0.01-0.69]；p=0.02）。城市和农村患者的生存无显著差异。
未婚或城市患者接受 AS/WW 的比例明显较高。保守治疗的利用和疗效受到社会经济因素的影响，这可能成为治疗决策的障碍，并针对需要社会支持的人群。
