National trends in the management of patients with positive surgical margins at radical prostatectomy.
National trends in the management of patients with positive surgical margins at radical prostatectomy.
复制标题
根治性前列腺切除术中手术切缘阳性患者管理的全国趋势。
DOI：
10.1007/s00345-020-03298-6
复制
发表时间：
2021
影响因子：
3.4
通讯作者：
Leapman,MichaelS
中科院分区：
文献类型：
--
作者：
Ghabili,Kamyar;Park,HenryS;Yu,JamesB;Sprenkle,PrestonC;Kim,SimonP;Nguyen,KevinA;Ma,Xiaomei;Gross,CaryP;Leapman,MichaelS
目的评价根治性前列腺癌根治术切缘阳性(PSM)男性患者术后放射治疗(RT)的实施模式。主要终点是在患者最初的治疗过程中接受计划的(RT)。我们研究了以RT为次要终点的RP后雄激素剥夺疗法(ADT)。结果在12个月内，87.0%的人没有接受计划的RT，8.5%的人接受了单纯的RT，1.3%的人接受了ADT，3.1%的人接受了RT加ADT。在多变量Logistic回归模型中，计划内放疗的使用与前列腺癌风险评估(CAPRA-S)类别的外科癌症(中级与低，OR = 2.87，95%CI 2.19-3.75，P<； 0.001；高与低，OR = 10.23，95%CI 7.79-13.43，P<； 0.001)、社区治疗与学术中心治疗(OR = 1.24，95%CI 1.15-1.34，P<； 0.001)，距离治疗设施的距离较短(OR = 为0.97，95%CI为0.96-0.98，P<； 0.001)，以及未投保状态(OR = 为1.39，95%CI为1.10-1.77，P= 0.005)。2014年接受计划RT的几率低于2010年(OR = 为0.76，95%CI为0.68-0.85，P<； 为0.001)。与RT相比，ADT的使用没有显著变化。高、低Capra-S分级与放射治疗加用ADT有关(OR = 5.13，95%CI1.57~16.80，P= 0.007)。结论前列腺良恶性病变患者术后计划RT的使用保持稳定，主要受其他不良病理因素的影响。
PurposeTo evaluate practice patterns of planned post-operative radiation therapy (RT) among men with positive surgical margins (PSM) at radical prostatectomy.MethodsWe identified 43,806 men within the National Cancer Database with pathologic node-negative prostate cancer diagnosed in 2010 through 2014 with PSM. The primary endpoint was receipt of planned (RT) within a patient’s initial course of treatment. We examined post-RP androgen deprivation therapy (ADT) with RT as a secondary endpoint. We evaluated patterns of post-operative management and characteristics associated with planned post-prostatectomy RT.ResultsWithin 12 months of RP, 87.0% received no planned RT, 8.5% RT alone, 1.3% ADT alone, and 3.1% RT with ADT. In a multivariable logistic regression model, planned RT use was associated with clinical and pathologic characteristics as estimated by surgical Cancer of the Prostate Risk Assessment (CAPRA-S) category (intermediate versus low, OR = 2.87, 95% CI 2.19–3.75,P< 0.001; high versus low, OR = 10.23, 95% CI 7.79–13.43,P< 0.001), treatment at community versus academic centers (OR = 1.24, 95% CI 1.15–1.34,P< 0.001), shorter distance to a treatment facility (OR = 0.97 for each 10-mile, 95% CI 0.96–0.98,P< 0.001), and uninsured status (OR = 1.39, 95% CI 1.10–1.77,P= 0.005). The odds of receiving planned RT were lower in 2014 versus 2010 (OR = 0.76, 95% CI 0.68–0.85,P< 0.001). There was no significant change in the use of ADT with RT. High versus low CAPRA-S category was associated with the use of ADT in addition to RT (OR = 5.13, 95% CI 1.57–16.80,P= 0.007).ConclusionThe use of planned post-prostatectomy RT remained stable among patients with PSM and appears driven primarily by the presence of other adverse pathologic features.