Contemporary prostate cancer treatment choices in multidisciplinary clinics referenced to national trends
Contemporary prostate cancer treatment choices in multidisciplinary clinics referenced to national trends
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DOI：
10.1002/cncr.32570
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发表时间：
2019-11-19
期刊：
影响因子：
6.2
通讯作者：
Kuban, Deborah A.
中科院分区：
文献类型：
--
作者：
Tang, Chad;Hoffman, Karen E.;Kuban, Deborah A.
本研究的目的是评估在德克萨斯大学MD安德森癌症中心多学科（MultiD）诊所就诊的前列腺癌患者的治疗选择，并与全国趋势进行比较。方法对2004年至2016年在MultiD诊所就诊的4451例前列腺癌男性患者进行了分析。为了评估全国范围内的趋势，作者分析了2004年至2015年期间从监测，流行病学和最终结果（SEER）数据库中诊断出的392，710名前列腺癌男性。主要终点是治疗选择作为治疗前人口统计学的函数。结果单变量分析显示MultiD和SEER队列的治疗趋势相似。随着年龄的增长，包括近距离放射治疗和直肠切除术在内的确定性治疗的使用率下降（所有P <0.05）。诊断/门诊就诊的后一年与确定性治疗的使用减少相关，而高风险组与使用增加相关（所有P <0.001）。在MultiD诊所接受治疗的低风险疾病患者比SEER中的患者更有可能接受非确定性治疗，而在高风险疾病患者中观察到相反的趋势，SEER中相当一部分高风险患者未接受确定性治疗。在MultiD临床中，患有中危和高危疾病的非裔美国男性比白色男性更有可能接受确定性治疗，但对于SEER，情况正好相反。结论在MultiD诊所就诊有助于将低风险疾病患者适当地安排为非确定性策略，将高风险疾病患者适当地安排为确定性治疗，并且可能消除种族的影响。
Background The purpose of this study was to assess treatment choices among men with prostate cancer who presented at The University of Texas MD Anderson Cancer Center multidisciplinary (MultiD) clinic compared with nationwide trends. Methods In total, 4451 men with prostate cancer who presented at the MultiD clinic from 2004 to 2016 were analyzed. To assess nationwide trends, the authors analyzed 392,710 men with prostate cancer who were diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. The primary endpoint was treatment choice as a function of pretreatment demographics. Results Univariate analyses revealed similar treatment trends in the MultiD and SEER cohorts. The use of procedural forms of definitive therapy decreased with age, including brachytherapy and prostatectomy (all P < .05). Later year of diagnosis/clinic visit was associated with decreased use of definitive treatments, whereas higher risk grouping was associated with increased use (all P < .001). Patients with low-risk disease treated at the MultiD clinic were more likely to receive nondefinitive therapy than patients in SEER, whereas the opposite trend was observed for patients with high-risk disease, with a substantial portion of high-risk patients in SEER not receiving definitive therapy. In the MultiD clinic, African American men with intermediate-risk and high-risk disease were more likely to receive definitive therapy than white men, but for SEER the opposite was true. Conclusions Presentation at a MultiD clinic facilitates the appropriate disposition of patients with low-risk disease to nondefinitive strategies of patients with high-risk disease to definitive treatment, and it may obviate the influence of race.