Nationally representative trends and geographic variation in treatment of localized prostate cancer: the Urologic Diseases in America project
Nationally representative trends and geographic variation in treatment of localized prostate cancer: the Urologic Diseases in America project
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DOI：
10.1038/pcan.2015.3
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发表时间：
2015-06-01
影响因子：
4.8
通讯作者：
Cooperberg, M. R.
中科院分区：
文献类型：
--
作者：
Cary, K. C.;Punnen, S.;Cooperberg, M. R.
背景：目前，根据既定指南，存在多种临床局限性前列腺癌的治疗选择。我们的目标是评估随时间推移的全国代表性治疗趋势，并使用两个大型国家索赔登记处确定潜在的地理差异。 方法：使用国际疾病分类 9 和当前程序术语 4 代码识别由 Medicare (1998-2006) 或私人保险公司（Ingenix 数据库，2002-2006）承保的前列腺癌男性。评估了随时间推移所使用的治疗类型的地理变化和趋势。使用 GeoCommons 在线地图平台绘制地理数据。使用 Logit 链接函数，使用分层广义线性混合模型确定任何治疗的预测因子。 结果：在私人保险 i3 数据库中，根治性前列腺切除术的使用增加了 33-48%，而在医疗保险人群中保持稳定在 12%。随着时间的推移，Medicare 和 i3 群体都迅速采用了新技术。 i3 患者中腹腔镜辅助前列腺切除术的使用率从 2002 年的 1% 增加到 2006 年的 41%，而 Medicare 患者的发生率从 2002 年的 3% 增加到 2006 年的 35%。 i3 队列中新辅助/辅助雄激素剥夺疗法的使用率较低，并且 i3 和 Medicare 中的新辅助/辅助雄激素剥夺疗法的使用率随着时间的推移而减少。医生密度对新英格兰地区接受的初级治疗类型有影响；然而，这种趋势在美国西部或南部地区并未出现。结论：通过两个大型国家索赔登记中心，我们已经证明了局部前列腺癌主要治疗类型随时间的变化趋势和显着的地理差异。具体来说，新技术（即腹腔镜辅助前列腺切除术和调强放射治疗）的使用大幅增加。这些结果阐明需要改进前列腺癌治疗结果的数据收集，以减少护理中不必要的变化。
BACKGROUND: Several treatment options for clinically localized prostate cancer currently exist under the established guidelines. We aim to assess nationally representative trends in treatment over time and determine potential geographic variation using two large national claims registries.METHODS: Men with prostate cancer insured by Medicare (1998-2006) or a private insurer (Ingenix database, 2002-2006) were identified using International Classification of Diseases-9 and Current Procedural Terminology-4 codes. Geographic variation and trends in the type of treatment utilized over time were assessed. Geographic data were mapped using the GeoCommons online mapping platform. Predictors of any treatment were determined using a hierarchical generalized linear mixed model using the logit link function.RESULTS: The use of radical prostatectomy increased, 33-48%, in the privately insured i3 database while remaining stable at 12% in the Medicare population. There was a rapid uptake in the use of newer technologies over time in both the Medicare and i3 cohorts. The use of laparoscopic-assisted prostatectomy increased from 1% in 2002 to 41% in 2006 in i3 patients, whereas the incidence increased from 3% in 2002 to 35% in 2006 for Medicare patients. The use of neoadjuvant/adjuvant androgen deprivation therapy was lower in the i3 cohort and has decreased over time in both i3 and Medicare. Physician density had an impact on the type of primary treatment received in the New England region; however, this trend was not seen in the western or southern regions of the United States.CONCLUSIONS: Using two large national claims registries, we have demonstrated trends over time and substantial geographic variation in the type of primary treatment used for localized prostate cancer. Specifically, there has been a large increase in the use of newer technologies (that is, laparoscopic-assisted prostatectomy and intensity-modulated radiation therapy). These results elucidate the need for improved data collection on prostate cancer treatment outcomes to reduce unwarranted variation in care.