泌尿科对新发前列腺癌患者使用多参数 MRI 和基因组检测与治疗的关联。
Association between urology practice use of multiparametric MRI and genomic testing and treatment of men with newly diagnosed prostate cancer.
机构信息
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
出版信息
Urol Oncol. 2023 Oct;41(10):430.e17-430.e23. doi: 10.1016/j.urolonc.2023.08.002. Epub 2023 Aug 12.
INTRODUCTION
Biomarkers for prostate cancer, such as multiparametric MRI (mpMRI) and tissue-based genomics, are increasingly used for treatment decision-making. Using biomarkers indiscriminately and thus ignoring competing risks of mortality may lead to treatment in some men who derive little clinical benefit. We assessed the relationship between urology practice use of biomarkers and subsequent treatment in men with newly diagnosed prostate cancer.
METHODS
We used a 20% random sample of national Medicare data to perform a retrospective cohort study of men with newly diagnosed prostate cancer diagnosed from 2015 through 2019. Urology practice-level use of biomarkers was characterized based on urology practice propensity to use either biomarker after diagnosis (never, below median, above the median). Noncancer mortality risk within 10 years of diagnosis was calculated for all men. Multilevel models were used to assess the relationship between practice-level biomarker use and treatment by noncancer mortality risk.
RESULTS
Between 2015 and 2019, 1,764 (65%) urology practices used mpMRI and 897 (33%) used genomic testing for prostate cancer. Compared with urology practices never using each biomarker, those using mpMRI above the median (56% vs. 47%, P = 0.003) and tissue-based genomics below the median (56% vs. 50%, P = 0.03) were more likely to treat men with >75% risk of noncancer mortality. Additionally, compared with urology practices never using either biomarker, use of mpMRI (72% vs. 69%, P = 0.07) or tissue-based genomics (71% vs. 70%, P = 0.65) did not impact treatment in the healthiest group (i.e., those with <25% risk of noncancer mortality).
CONCLUSIONS
Compared to practices that do not use each biomarker in men with newly diagnosed prostate cancer, urology practices using mpMRI, and tissue-based genomics to a lesser extent, are more likely to treat men at very high risk of dying from competing risks of mortality within 10 years of prostate cancer diagnosis.
简介
前列腺癌的生物标志物，如多参数 MRI（mpMRI）和基于组织的基因组学，越来越多地用于治疗决策。不加区分地使用生物标志物，从而忽略死亡的竞争风险，可能导致一些从治疗中获益甚微的男性接受治疗。我们评估了新诊断前列腺癌患者的泌尿科实践中使用生物标志物与后续治疗之间的关系。
方法
我们使用国家医疗保险数据的 20%随机样本，对 2015 年至 2019 年期间新诊断为前列腺癌的男性进行回顾性队列研究。根据诊断后使用生物标志物的倾向（从不、低于中位数、高于中位数）来描述泌尿科实践中生物标志物的使用情况。计算所有男性在诊断后 10 年内非癌症死亡风险。使用多水平模型评估实践水平生物标志物使用与非癌症死亡风险相关的治疗之间的关系。
结果
在 2015 年至 2019 年间，1764 个（65%）泌尿科实践使用了 mpMRI，897 个（33%）使用了基因组检测用于前列腺癌。与从不使用每种生物标志物的泌尿科实践相比，使用中位数以上的 mpMRI（56%比 47%，P=0.003）和中位数以下的组织基因组学（56%比 50%，P=0.03）的实践更有可能治疗非癌症死亡风险>75%的男性。此外，与从不使用任何生物标志物的泌尿科实践相比，使用 mpMRI（72%比 69%，P=0.07）或组织基因组学（71%比 70%，P=0.65）并没有影响最健康组（即非癌症死亡风险<25%）的治疗。
结论
与不使用每种生物标志物的实践相比，使用 mpMRI 和在较小程度上使用组织基因组学的泌尿科实践更有可能治疗在前列腺癌诊断后 10 年内因竞争死亡风险而极有可能死亡的男性。
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