A decision analysis of alternative treatment strategies for clinically localized prostate cancer. Prostate Patient Outcomes Research Team.
A decision analysis of alternative treatment strategies for clinically localized prostate cancer. Prostate Patient Outcomes Research Team.
复制标题
临床局限性前列腺癌替代治疗策略的决策分析。
DOI：
--
复制
发表时间：
1993
期刊：
影响因子：
--
通讯作者：
R. Bruskewitz
中科院分区：
文献类型：
--
作者：
C. Fleming;J. Wasson;P. Albertsen;M. J. Barry;J. Wennberg;T. Bubolz;Catherine C. Lindsay;B. Littenberg;A. B. Flood;G. Lu;Chiang;A. Mulley;C. Coley;F. J. Fowler;R. Bruskewitz
目的
模拟初始治疗对局限性（临床分期A或B）前列腺癌男性患者结局的影响。
设计
一个决策分析模型的三个策略：根治性乳腺癌切除术，外束放射治疗，和观察等待，与延迟激素治疗，如果转移性疾病的发展。我们将治疗的主要益处建模为减少转移性疾病的死亡或负效用的机会。在该模型中，这些益处被治疗相关发病率和死亡率的风险所抵消。该模型用于分析60至75岁男性的肿瘤分级（良好，中度和低分化）的预期结果。
数据
重要临床事件的概率和发生率，通过审查前列腺癌的文献和分析Medicare索赔数据获得。
主要结果
在前列腺癌治疗的风险和获益的不确定性范围内出现了几种模式。根据临床分期，在分化良好的肿瘤分级患者中，治疗充其量只能在质量调整的预期寿命方面提供有限的益处，并可能对患者造成伤害。在中分化或低分化肿瘤患者中，如果我们对治疗效果采用最乐观的假设，那么与观察等待相比，60至65岁的患者将从根治性直肠癌切除术或外照射放射治疗中获益。然而，在大多数其他情况下，与观察等待相比，治疗对质量调整预期寿命的改善不到1年，或者降低了质量调整预期寿命。侵入性治疗通常对70岁以上的患者有害。
结论
根治性前列腺切除术和放射治疗可能有益于选定的局限性前列腺癌患者群体，特别是患有高级别肿瘤的年轻患者。然而，我们的模型表明，在大多数情况下，治疗的潜在好处是足够小的治疗的选择是敏感的患者的偏好，各种结果和折扣。对于许多局限性前列腺癌患者，选择观察等待是侵入性治疗的合理替代方案。
OBJECTIVE
To model the impact of initial therapy on outcomes for men with localized (clinical stage A or B) prostatic carcinoma.
DESIGN
A decision analysis modeling three strategies: radical prostatectomy, external-beam radiation therapy, and watchful waiting, with delayed hormonal therapy if metastatic disease develops. We modeled the main benefit of treatment as a reduction in the chance of death or disutility from metastatic disease. These benefits were offset in the model by the risks of treatment-related morbidity and mortality. The model was used to analyze expected outcomes by tumor grade (well, moderately, and poorly differentiated) for men 60 to 75 years of age.
DATA
Probabilities and rates for important clinical events, obtained through review of the literature for prostatic carcinoma and analysis of Medicare claims data.
MAIN RESULTS
Several patterns emerged within the range of uncertainty about the risks and benefits of treatment for prostatic carcinoma. In patients with well-differentiated tumor grades, based on clinical staging, treatment at best offers limited benefit in terms of quality-adjusted life expectancy and may result in harm to the patient. Among patients with moderately or poorly differentiated tumors, if we use the most optimistic assumptions about treatment efficacy, then patients aged 60 to 65 years would benefit from either radical prostatectomy or external-beam radiation therapy, compared with watchful waiting. However, in most other cases, treatment offers less than a 1-year improvement in quality-adjusted life expectancy or decreases the quality-adjusted life expectancy compared with watchful waiting. Invasive treatment generally appears to be harmful for patients older than 70 years.
CONCLUSIONS
Radical prostatectomy and radiation therapy may benefit selected groups of patients with localized prostate cancer, particularly younger patients with higher-grade tumors. However, our model shows that in most cases the potential benefits of therapy are small enough that the choice of therapy is sensitive to the patient's preferences for various outcomes and discounting. The choice of watchful waiting is a reasonable alternative to invasive treatment for many men with localized prostatic carcinoma.
DOI：
10.1001/jama.1993.03500200047031
发表时间：
1993-05
期刊：
JAMA
影响因子：
--
作者：
Grace L. Lu-Yao;D. McLerran;J. Wasson;J. Wennberg;T. Bubolz;Catherine C. Lindsay;B. Littenberg;A. Flood;Chiang-Hua Chang;A. Mulley;M. J. Barry;C. Coley;F. J. Fowler;R. Bruskewitz;P. Albertson;C. Fleming
通讯作者：
Grace L. Lu-Yao;D. McLerran;J. Wasson;J. Wennberg;T. Bubolz;Catherine C. Lindsay;B. Littenberg;A. Flood;Chiang-Hua Chang;A. Mulley;M. J. Barry;C. Coley;F. J. Fowler;R. Bruskewitz;P. Albertson;C. Fleming