Agbo Christian Agbo, Tolani Musliu Adetola, Ojewola Rufus Wale
Department of Surgery, Benue State University, Makurdi/Federal University Teaching Hospital, Lafia, Nigeria.
Department of Surgery, Ahmadu Bello University, Zaria, Nigeria.
Niger Postgrad Med J. 2025 Jul 1;32(3):211-213. doi: 10.4103/npmj.npmj_50_25. Epub 2025 Aug 1.
Patients with clinically localised prostate cancer (CaP) have a potentially curable disease. However, there are gaps in the quality of care these patients receive in Nigeria. Granular clinical data are needed to design interventions for quality improvement.
This study aimed to describe guideline concordance of cancer management and its association with patient outcomes.
A 3-year retrospective study of all patients with T1-T3a, N0, M0 CaP at three tertiary hospitals in Nigeria was conducted. Data on clinicopathologic characteristics, D'Ámico risk group, TNM staging, treatment practices, post-treatment PSA and survival were collected. Concordance with the 2022 European Association of Urology guideline was assessed. Primary endpoints were guideline concordance of staging and treatment, and associations between concordance and outcomes.
This study included 110 patients with mean age of 68 years. Sixty-seven patients (60.9%) were high-risk, 34 (30.9%) were intermediate-risk and 9 (82%) were low-risk. Most patients were staged with abdominopelvic ultrasound (65%, n = 71). Guideline-concordant magnetic resonance imaging for T-staging was significantly higher in low-risk (44%, n = 4) than in high-risk (12%, n = 8) patients (P = 0.041). Guideline-concordant axial imaging for N and M staging was used in 11% (n = 7) of high-risk patients. In the overall cohort, 17 patients (15%) received guideline-concordant definitive treatment with either radical prostatectomy (n = 8; 9%) or radiotherapy (n = 9; 5%), whereas 52 patients (56%) received non-concordant androgen deprivation therapy (ADT) alone and 43 received no treatment. Median time to biochemical recurrence was not significantly different between those who received surgery (18 months), radiation therapy (median not obtained) or ADT alone (11 months) (log-rank P = 0.103). After a median follow-up of 36 months, median overall survival was similar for guideline-concordant and non-concordant treatment groups (37 and 34 months, respectively; log-rank P = 0.540).
CaP staging was suboptimal across all risk groups. Only a minority of patients received radical treatment for this potentially curable disease. Our results will inform the development of tailored multifaceted interventions to improve the quality of care.
临床局限性前列腺癌（CaP）患者的疾病有潜在治愈可能。然而，尼日利亚这些患者所接受的医疗服务质量存在差距。需要详细的临床数据来设计质量改进干预措施。
本研究旨在描述癌症管理的指南一致性及其与患者预后的关联。
对尼日利亚三家三级医院所有T1 - T3a、N0、M0期CaP患者进行了为期3年的回顾性研究。收集了临床病理特征、达米科风险组、TNM分期、治疗方法、治疗后前列腺特异抗原（PSA）及生存情况的数据。评估了与2022年欧洲泌尿外科学会指南的一致性。主要终点为分期和治疗的指南一致性，以及一致性与预后的关联。
本研究纳入110例患者，平均年龄68岁。67例（60.9%）为高危患者，34例（30.9%）为中危患者，9例（8.2%）为低危患者。大多数患者通过腹部盆腔超声进行分期（65%，n = 71）。低危患者（44%，n = 4）中用于T分期的符合指南的磁共振成像显著高于高危患者（12%，n = 8）（P = 0.041）。11%（n = 7）的高危患者使用了符合指南的用于N和M分期的轴向成像。在整个队列中，17例患者（15%）接受了符合指南的根治性治疗，包括根治性前列腺切除术（n = 8；9%）或放疗（n = 9；5%），而52例患者（56%）仅接受了不符合指南的雄激素剥夺治疗（ADT），43例未接受治疗。接受手术的患者（18个月）、接受放疗的患者（未获得中位数）或仅接受ADT的患者（11个月）之间生化复发的中位时间无显著差异（对数秩检验P = 0.103）。中位随访36个月后，符合指南和不符合指南的治疗组的中位总生存期相似（分别为37个月和34个月；对数秩检验P = 0.540）。
所有风险组的CaP分期均未达到最佳。对于这种有潜在治愈可能的疾病，只有少数患者接受了根治性治疗。我们的结果将为制定针对性的多方面干预措施以提高医疗服务质量提供依据。
