Real-World Use of Bone-Modifying Agents in Metastatic Castration-Sensitive Prostate Cancer.
Real-World Use of Bone-Modifying Agents in Metastatic Castration-Sensitive Prostate Cancer.
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骨改性剂在转移性去势敏感前列腺癌中的实际应用。
DOI：
10.1093/jnci/djab196
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Morris,MichaelJ
中科院分区：
文献类型：
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作者：
Mitchell,AaronP;MishraMeza,Akriti;Panageas,KatherineS;Lipitz-Snyderman,Allison;Bach,PeterB;Morris,MichaelJ
背景骨修饰剂（BMA）治疗被推荐用于转移性去势抵抗性前列腺癌，但不推荐用于转移性去势敏感性前列腺癌（mCSPC）。BMA治疗mCSPC可能因此构成overuse.MethodsIn这个回顾性队列研究使用链接的监测，流行病学，和最终结果，医疗保险数据，我们包括患者诊断为IV期前列腺癌从2007年至2015年谁是66岁或以上的诊断，并已接受雄激素剥夺或抗雄激素治疗。我们排除了既往接受过BMAs治疗或存在骨质疏松、骨质减少、高钙血症或既往骨折的患者。主要结局是在诊断后180天内接受BMA（唑来膦酸或地舒单抗）（在此时间范围内不太可能出现CRPC）。次要结局是在90天内接受BMA。曝光的利益包括实践的位置（医生办公室与医院门诊）和专业（医疗肿瘤学家与泌尿科医生）的治疗medicinal.ResultsOur样本包括2627例患者，其中52.9%的医疗肿瘤学家和47.1%的泌尿科医生治疗，77.7%和22.3%的医生办公室和医院门诊的位置，分别接受护理。总体而言，23.6%在180天内接受了BMA; 18.4%在90天内接受了BMA。BMA治疗在肿瘤科医生治疗的患者（比值比= 8.23，95%置信区间= 6.41至10.57）和医生办公室（比值比= 1.33，95%置信区间= 1.06至1.69）中更常见。利用率有所提高：2007 - 2009年，17.3%的患者接受了BMA治疗（17.3%唑来膦酸，0%地舒单抗），2012 - 2015年，28.1%的患者接受了BMA治疗（8.4%唑来膦酸，20.3%地舒单抗）。这种过度使用可能导致成本过高和毒性。
BackgroundBone-modifying agent (BMA) therapy is recommended for metastatic castration-resistant prostate cancer but not metastatic castration-sensitive prostate cancer (mCSPC). BMA treatment in mCSPC may therefore constitute overuse.MethodsIn this retrospective cohort study using linked Surveillance, Epidemiology, and End Results–Medicare data, we included patients diagnosed with stage IV prostate adenocarcinoma from 2007 to 2015 who were 66 years of age or older at diagnosis and had received androgen-deprivation or antiandrogen therapy. We excluded patients who had previously received BMAs or had existing osteoporosis, osteopenia, hypercalcemia, or prior bone fracture. The primary outcome was receipt of BMA (zoledronic acid or denosumab) within 180 days of diagnosis (emergence of CRPC within this time frame is unlikely). The secondary outcome was receipt of a BMA within 90 days. Exposures of interest included practice location (physician office vs hospital outpatient) and the specialty (medical oncologist vs urologist) of the treating physician.ResultsOur sample included 2627 patients, of whom 52.9% were treated by medical oncologists and 47.1% by urologists; 77.7% and 22.3% received care in physician office and hospital outpatient locations, respectively. Overall, 23.6% received a BMA within 180 days; 18.4% did within 90 days. BMA therapy was more common among patients treated by oncologists (odds ratio = 8.23, 95% confidence interval = 6.41 to 10.57) and in physician office locations (odds ratio = 1.33, 95% confidence interval = 1.06 to 1.69). Utilization has increased: 17.3% of patients received BMAs from 2007 to 2009 (17.3% zoledronic acid, 0% denosumab) and 28.1% from 2012 to 2015 (8.4% zoledronic acid, 20.3% denosumab).ConclusionsAmong patients with mCSPC who had no evidence of high osteoporotic fracture risk, more than one-quarter have received BMAs in recent years. This overuse may lead to excess costs and toxicity.