Mettlin C J, Murphy G P, Rosenthal D S, Menck H R
Cancer Control and Epidemiology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Cancer. 1998 Oct 15;83(8):1679-84. doi: 10.1002/(sici)1097-0142(19981015)83:8<1679::aid-cncr24>3.0.co;2-y.
Prostate carcinoma incidence has been declining since 1992 after a period of marked increase. Recent data from the National Cancer Data Base (NCDB) were examined to assess changes in prostate carcinoma patient characteristics and disease and treatment patterns coincidental to this decline. The NCDB is a program of the American College of Surgeons Commission on Cancer and the American Cancer Society that collects timely data from institutions representing every level of cancer care.
Data from 1114 hospitals regarding 103,979 patients diagnosed with prostate carcinoma in 1992 and from 1144 hospitals regarding 72,337 patients diagnosed in 1995 were studied. Patient and disease characteristics studied included age, race, American Joint Committee on Cancer stage, and tumor histologic grade. Trends in treatment and variations in treatment by region also were examined.
The average age at diagnosis declined by 2 years over the period studied and the proportion of patients identified as African-American increased from 8.8% to 11.8%. The proportion of patients diagnosed with localized disease and the proportion of tumors of moderately differentiated histologic grade increased. The overall proportion of patients treated by radical prostatectomy increased and the use of external beam radiation treatment decreased. Substantial regional variation in treatment patterns was observed. The Pacific and Mountain state regions of the U. S. had the highest proportions of patients treated by radical prostatectomy although increases were occurring in other regions. Use of external beam radiation treatment was highest in the Northeast and Southeast states and was declining in the majority of regions. Use of brachytherapy radiation treatment by implantation of radioactive seeds was infrequent but increasing.
Comparison of the basic characteristics of prostate carcinoma data from 1992 and 1995 shows that patients are being diagnosed at younger ages and earlier stages, the proportion of African-Americans has increased, and more patients are being treated for cure. Regional differences in patterns of care persist but may be moderating. The annual prostate carcinoma death rate in the U.S. has declined an average of 1% per year since 1990.
在经历一段显著增长期后，自1992年起前列腺癌发病率一直在下降。研究了美国国立癌症数据库（NCDB）的最新数据，以评估前列腺癌患者特征、疾病及治疗模式随发病率下降所发生的变化。NCDB是美国外科医师学会癌症委员会和美国癌症协会的一个项目，它从代表各级癌症治疗水平的机构及时收集数据。
研究了1114家医院提供的1992年确诊为前列腺癌的103979例患者的数据以及1144家医院提供的1995年确诊为前列腺癌的72337例患者的数据。所研究的患者和疾病特征包括年龄、种族、美国癌症联合委员会分期以及肿瘤组织学分级。还研究了治疗趋势以及各地区治疗方法的差异。
在所研究的时间段内，确诊时的平均年龄下降了2岁，被认定为非裔美国人的患者比例从8.8%增至11.8%。诊断为局限性疾病的患者比例以及组织学分级为中等分化的肿瘤比例有所增加。接受根治性前列腺切除术治疗的患者总体比例上升，而外照射放疗的使用减少。观察到治疗模式存在显著的地区差异。美国太平洋和山区州接受根治性前列腺切除术治疗的患者比例最高，不过其他地区也在增加。外照射放疗在东北部和东南部各州的使用最为频繁，且在大多数地区呈下降趋势。通过植入放射性粒子进行近距离放疗的使用并不常见，但在增加。
对1992年和1日5年前列腺癌数据基本特征的比较表明，患者被诊断时年龄更小、分期更早，非裔美国人比例增加，且更多患者接受根治性治疗。护理模式的地区差异依然存在，但可能正在缓和。自1990年以来，美国前列腺癌年死亡率平均每年下降1%。
