Desch C E, Penberthy L, Newschaffer C J, Hillner B E, Whittemore M, McClish D, Smith T J, Retchin S M
Department of Internal Medicine, Medical College of Virginia/Virginia Commonwealth University, Richmond 23298-0037, USA.
Med Care. 1996 Feb;34(2):152-62. doi: 10.1097/00005650-199602000-00007.
This article assesses the significance of comorbid and nonclinical factors in type of treatment received by elderly male patients with local-regional stage prostate cancer. Multivariate analysis of data from the Virginia Cancer Registry was linked to Medicare claim files, the Area Resource File, and 1990 Census Data. The type of initial treatment received was studied in 3117 men with local-regional staged prostate cancer diagnosed from 1985 to 1989. The frequency of surgical and radiation therapy for prostate cancer rose between 1985 and 1989 (12.5% to 18.5% for surgery, P < 0.001; 25% to 32% for radiation, P < 0.001). Age was the most important predictor of therapeutic choice; no therapy was given to 26% of men 65 to 69 years old versus 63% of men 85 years or older P < 0.001). Race, residence (rural versus urban), and comorbidity were also strong factors in predicting initial therapy. Using logistic regression, three treatment alternatives were evaluated. Age (odds ratio [OR] .51; 99% confidence interval [CI] = .43, .60), comorbidity (OR .72; 99% CI .63, .82), income (OR 1.14; 99% CI 1.01, 1.28), residence (OR .65; 99% CI .48, .87), diagnosis year (OR 1.15; 99% CI 1.07, 1.23) all were associated independently with treatment versus no treatment. For surgery versus radiation, age (OR .40; 99% CI .27, .57), race (OR 2.92; 99% CI 1.65, 5.15) and education (OR 1.75; 99% CI 1.31, 2.34) were significant factors. For hormonal/orchiectomy versus surgery/radiation, age (OR 5.19; 99% CI 3.84, 7.01), comorbidity (OR 1.28; 99% CI 1.03, 1.58), distance to radiation oncologist (OR .89; 99% CI .80, .99), and diagnosis year (OR .89; 99% CI .79, 1.00) were significant. The number of men receiving surgical and radiation treatments for prostate cancer increased between 1985 and 1989. During that period, age consistently played a significant role in all therapeutic decisions. Other factors, such as comorbidity, race, socioeconomic status, and distance, also were important considerations, depending on the treatment alternative.
本文评估了合并症和非临床因素在局部区域性前列腺癌老年男性患者接受治疗类型方面的重要性。对弗吉尼亚癌症登记处的数据进行多变量分析，并与医疗保险理赔档案、区域资源档案和1990年人口普查数据相关联。研究了1985年至1989年期间诊断为局部区域性前列腺癌的3117名男性患者接受的初始治疗类型。1985年至1989年期间，前列腺癌手术和放射治疗的频率有所上升（手术从12.5%升至18.5%，P<0.001；放射治疗从25%升至32%，P<0.001）。年龄是治疗选择的最重要预测因素；65至69岁男性中有26%未接受任何治疗，而85岁及以上男性中有63%未接受任何治疗（P<0.001）。种族、居住情况（农村与城市）和合并症也是预测初始治疗的重要因素。使用逻辑回归分析，评估了三种治疗方案。年龄（比值比[OR].51；99%置信区间[CI]=.43，.60）、合并症（OR.72；99%CI.63，.82）、收入（OR 1.14；99%CI 1.01，1.28）、居住情况（OR.65；99%CI.48，.87）、诊断年份（OR 1.15；99%CI 1.07，1.23）均与接受治疗与否独立相关。对于手术与放射治疗，年龄（OR.40；99%CI.27，.57）、种族（OR 2.92；99%CI 1.65，5.15）和教育程度（OR 1.75；99%CI 1.31，2.34）是显著因素。对于激素/睾丸切除术与手术/放射治疗，年龄（OR 5.19；99%CI 3.84，7.01）、合并症（OR 1.28；99%CI 1.03，1.58）、到放射肿瘤学家的距离（OR.89；99%CI.80，.99）和诊断年份（OR.89；99%CI.79，1.00）是显著因素。1985年至1989年期间，接受前列腺癌手术和放射治疗的男性人数增加。在此期间，年龄在所有治疗决策中始终发挥着重要作用。其他因素，如合并症、种族、社会经济地位和距离，也根据治疗方案的不同而成为重要的考虑因素。
