前列腺癌分级迁移与分级分组 1 疾病的医疗机构治疗趋势。
Prostate cancer grade migration and facility-level treatment trends for grade group 1 disease.
机构信息
Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, NY, USA.
Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA.
出版信息
JNCI Cancer Spectr. 2023 Mar 1;7(2). doi: 10.1093/jncics/pkad018.
Overdiagnosis and overtreatment of low-grade prostate cancer (PCa) reflect poor quality of care and prompted changes to guidelines over the past decade. We used the National Cancer Database to characterize Gleason Grade Group (GG)1 PCa diagnosis trends and assess facility-level treatment variability. Between 2010 and 2019, GG1 PCa incidence had a clinically and statistically significant decline, from 45% to 25% at biopsy and from 33% to 9.8% at radical prostatectomy (RP) pathology. Similarly, active surveillance (AS) uptake significantly increased to 49% and 62% among nonacademic and academic sites, respectively. Decreasing rates of definitive therapies were identified: among academic sites, RP decreased from 61.1% to 25.3% and radiation therapy (RT) from 25.2% to 12%, whereas among nonacademic sites, RP decreased from 53.6% to 28% and RT from 37.8% to 21.9% (Ptrend < .001). Declines in the diagnosis and treatment of low-grade disease demonstrate an encouraging shift in PCa epidemiology. However, heterogeneity in AS utilization remains and reflects opportunities for improvement.
低级别前列腺癌（PCa）的过度诊断和过度治疗反映了医疗质量的低下，并促使过去十年间指南发生了改变。我们使用国家癌症数据库来描述 Gleason 分级组（GG）1 PCa 的诊断趋势，并评估医疗机构之间治疗的差异性。在 2010 年至 2019 年期间，GG1 PCa 的发病率在活检时从 45%降至 25%，在根治性前列腺切除术（RP）病理时从 33%降至 9.8%，这一变化具有临床和统计学意义。同样，主动监测（AS）的采用率在非学术和学术医疗机构中分别显著增加到 49%和 62%。明确治疗方法的应用率呈下降趋势：在学术医疗机构中，RP 从 61.1%降至 25.3%，放射治疗（RT）从 25.2%降至 12%，而非学术医疗机构中，RP 从 53.6%降至 28%，RT 从 37.8%降至 21.9%（P<0.001）。低级别疾病的诊断和治疗的减少表明 PCa 流行病学出现了令人鼓舞的转变。然而，AS 的应用仍然存在异质性，这反映了改进的机会。
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