Trends in prostatectomy utilization: Increasing upfront prostatectomy and postprostatectomy radiotherapy for high-risk prostate cancer.
Trends in prostatectomy utilization: Increasing upfront prostatectomy and postprostatectomy radiotherapy for high-risk prostate cancer.
复制标题
作者：
Kaps B;Leapman M;An Y
我们的目的是确定前列腺癌放疗频率的模式和明确的手术治疗。有前瞻性证据表明放射治疗对根治性乳腺癌切除术（根治术）后的一些患者有益，最近的证据表明早期挽救性放射治疗有益。术后放疗的趋势尚未阐明。我们分析了2004年至2016年间接受治疗性治疗的前列腺癌患者的国家癌症数据库。根据NCCN治疗指南对患者进行风险分层。采用线性回归分析了治疗风险组中初次直肠癌切除术治疗的趋势和术后放疗的趋势。采用多变量logistic回归分析与直肠癌切除术和术后放疗相关的临床人口统计学变量。从2004年到2016年，508，450名患者接受了乳房切除术，370，314名患者接受了放射治疗。中位年龄为63.6岁。直肠癌切除术的使用率从2004年的47.9%增加到2016年的61.3%（p趋势<0.001）。术后放疗24,466例。同样，术后放疗利用率从2004年的2.2%增加到2016年的4.0%（p趋势<0.001）。术后放疗增加最多的亚组是临床高危疾病（2004年为5.3%，2016年为7.8%（ptrend <0.001））。临床高危疾病（OR 1.751）、Gleason 9 - 10（OR 2.973）和PSA >20 ng/ml（OR 1.489）是术后放疗的预测因素。前列腺癌患者接受根治性前列腺切除术和术后放疗的比例正在增加。这种增加在高风险病例中最大。总体而言，接受任何放疗的患者比例正在下降。与临床前因素的相关性表明应考虑优化患者选择。前列腺切除术作为局部前列腺癌的主要治疗方法的使用率一直在增加。随着前列腺切除术使用率的增加，接受术后放射治疗的患者数量也有所增加，主要是临床高风险局部前列腺癌患者。
We aimed to determine patterns in frequency of radiotherapy for prostate cancer and definitive surgical management. There is prospective evidence indicating benefits of radiotherapy for some patients after radical prostatectomy (prostatectomy), with recent evidence suggesting benefit of early salvage radiotherapy. Trends in postoperative radiotherapy have not been elucidated. We analyzed the National Cancer Database for prostate cancer patients treated with curative‐intent therapy between 2004 and 2016. Patients were risk stratified according to NCCN treatment guidelines. Linear regression was utilized to examine trends in treatment with initial prostatectomy and trends in postoperative radiotherapy among treatment risk groups. Multivariable logistic regression was utilized to examine clinical‐demographic variables associated with prostatectomy and postoperative radiotherapy. From 2004 to 2016, 508,450 patients received prostatectomy and 370,314 received radiotherapy. Median age was 63.6 years. There was increased utilization of prostatectomy from 47.9% in 2004 to 61.3% in 2016 (ptrend <0.001). 24,466 cases received postoperative radiotherapy. Similarly, postoperative radiotherapy utilization increased from 2.2% in 2004 to 4.0% in 2016 (ptrend <0.001). The subgroup with the largest increase in postoperative radiotherapy was clinically high‐risk disease (5.3% in 2004 to 7.8% in 2016 (ptrend <0.001). Clinical high‐risk disease (OR 1.751), Gleason 9‐10 (OR 2.973), and PSA >20 ng/ml (OR 1.489) were factors predictive for postoperative radiotherapy. The proportion of prostate cancer patients who undergo definitive prostatectomy and postoperative radiotherapy is increasing. This increase is greatest in high‐risk cases. Overall, the proportion of patients who receive any radiotherapy is decreasing. Association with preclinical factors suggests optimization of patient selection should be considered. Utilization of prostatectomy for primary treatment of local prostate cancer has been increasing. With this increased utilization of prostatectomy, an increase has also been seen in the number of patients receiving postoperative radiation therapy, principally among patients with clinically high‐risk local prostate cancers.
登录
查看更多内容
影响因子：
3.7
作者：
Bilimoria KY;Stewart AK;Winchester DP;Ko CY
通讯作者：
Ko CY
影响因子：
6.2
作者：
Stitzenberg, Karyn B.;Wong, Yu-Ning;Uzzo, Robert G.
通讯作者：
Uzzo, Robert G.
影响因子：
6.6
作者：
Hoffman, Karen E.;Nguyen, Paul L.;D'Amico, Anthony V.
通讯作者：
D'Amico, Anthony V.
影响因子：
3.7
作者：
Lerro, Catherine C.;Robbins, Anthony S.;Stewart, Andrew K.
通讯作者：
Stewart, Andrew K.
DOI：
10.1097/coc.0000000000000323
发表时间：
2018-06-01
影响因子：
2.6
作者：
Kishan, Amar U.;Duchesne, Gillian;King, Christopher R.
通讯作者：
King, Christopher R.