The Impact of Socioeconomic Status on Prostate Cancer Treatment and Survival in the Southern Netherlands
The Impact of Socioeconomic Status on Prostate Cancer Treatment and Survival in the Southern Netherlands
复制标题
DOI：
10.1016/j.urology.2012.11.011
复制
发表时间：
2013-03-01
期刊：
影响因子：
2.1
通讯作者：
Louwman, Marieke
中科院分区：
文献类型：
--
作者：
Aarts, Mieke J.;Koldewijn, Evert L.;Louwman, Marieke
目的探讨社会经济地位（SES）在前列腺癌治疗方案选择和总生存期中的作用。方法：研究1998-2008年埃因霍温癌症登记处（n = 11086）所有新诊断的前列腺癌患者的SES治疗和生存率。结果：与高SES的患者相比，低SES的早期疾病（包括前列腺特异性抗原（PSA）检测到的cT1c期）的年轻患者（< 75岁）接受前列腺切除术和近距离治疗的频率较低（低SES的前列腺切除术率低10%-16%，低SES的近距离治疗率低0%-7%），但接受更多的外束放疗、激素治疗和观察等待政策（低SES分别增加6%-9%、5%-7%和3%-7%）。这部分与合并症的流行有关。局部疾病的近距离治疗首先出现在高SES患者中，这些社会经济差异在存在合并症时几乎不受社会经济差异的影响。高SES患者的总体10年生存率优于低SES患者（局部疾病67% vs 44%，晚期疾病29% vs 20%），并且与治疗和合并症有关。低ses患者的多变量调整死亡率仍然显著升高，尤其是cT1c、年龄< 60岁的患者（风险比[HR](low_vs_high_SES) 4.2, 95%可信区间[CI]1.3-13.7）。结论：SES影响了荷兰南部前列腺癌患者的治疗选择和总体生存，那里有治疗指南，医疗保健也完全覆盖。合并症的存在只是造成这些差异的部分原因。与ses相关的其他因素（如理解医疗信息或处理健康问题的能力）的关系仍有待探索。中华泌尿外科杂志（英文版），2013。(C) 2013爱思唯尔公司
OBJECTIVE To investigate if socioeconomic status (SES) played a role in the selection of prostate cancer treatment and overall survival.METHODS Treatment and survival by SES of all newly diagnosed patients with prostate cancer (1998-2008) from the population-based Eindhoven Cancer Registry (n = 11,086) were studied.RESULTS Younger patients (< 75) with early stage disease, including prostate-specific antigen (PSA)-detected stage cT1c, with low SES underwent prostatectomy and brachytherapy less often (10%-16% lower prostatectomy rates in low SES and 0%-7% lower brachytherapy rates in low SES) compared to those with high SES, but underwent more external beam radiotherapy, hormonal therapy, and watchful waiting policy (6%-9%, 5%-7%, and 3%-7% more in lowSES, respectively). This was partially related to the prevalence of comorbidity. The introduction of brachytherapy for localized disease occurred first in high SES patients and these socioeconomic differences were hardly affected by socioeconomic differences in the presence of comorbidities. Overall 10-year survival was superior in high SES patients compared to low SES (localized disease 67% vs 44%, advanced disease 29% vs 20%), and was related to treatment and comorbidity. Multivariable adjusted death rates remained significantly elevated for patients with lowSES, especially cT1c, age < 60 (hazard ratio [HR](low_vs_high_SES) 4.2, 95% confidence interval [CI]1.3-13.7).CONCLUSION SES affected treatment selection and overall survival for patients with prostate cancer in the Southern Netherlands, where treatment guidelines exist and health care is fully covered. Presence of comorbidities only partly contributed to these differences. The relation with other SES-associated factors (eg, ability to understand medical information or to cope with health problems) remains to be explored. UROLOGY 81: 593-601, 2013. (C) 2013 Elsevier Inc.