Increasing Utilization of Multiparametric Magnetic Resonance Imaging in Prostate Cancer Active Surveillance
Increasing Utilization of Multiparametric Magnetic Resonance Imaging in Prostate Cancer Active Surveillance
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DOI：
10.1016/j.urology.2019.02.037
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发表时间：
2019-08-01
期刊：
影响因子：
2.1
通讯作者：
Jacobs, Bruce L.
中科院分区：
文献类型：
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作者：
Fam, Mina M.;Yabes, Jonathan G.;Jacobs, Bruce L.
目的探讨多参数磁共振成像（mpMRI）在男性医疗保险受益人选择前列腺癌主动监测中的应用。mpMRI已经成为一种工具，可以改善风险分层，减少男性选择主动监测的重复活检。然而，mpMRI在主动监测中的应用程度尚未确定。方法利用监测、流行病学和与医疗保险索赔数据相关的最终结果登记数据，我们确定了2008年至2013年间诊断为局限性前列腺癌的男性，并进行了主动监测。我们将男性分为两个治疗组：不进行mpMRI的主动监测组和有mpMRI的主动监测组。然后，我们拟合了一个多变量逻辑回归模型，以检查随时间变化的mpMRI利用率，以及与mpMRI接收相关的因素。结果：9467名男性接受了主动监测。其中8178例（86%）未接受mpMRI， 1289例（14%）接受mpMRI。在整个研究期间接受mpMRI的可能性增加了3.7% （P = 0.004）。在多变量logistic回归中，年轻、白人、合并症负担较低、居住在东北和西部、收入较高、居住在更多城市地区的患者接受mpMRI的几率更高（均P < 0.05）。结论2008 - 2013年，mpMRI在主动监测中的应用逐渐增多，但明显增多。在接受前列腺癌监测的男性中，mpMRI的接受情况在人口统计学、地理和社会经济阶层之间存在显著差异。展望未来，研究应该调查这种差异的原因，并确定公平、具有成本效益的mpMRI技术传播的理想策略。(C) 2019 Elsevier Inc.
OBJECTIVE To characterize the use of multiparametric magnetic resonance imaging (mpMRI) in male Medicare beneficiaries electing active surveillance for prostate cancer. mpMRI has emerged as a tool that may improve risk-stratification and decrease repeated biopsies in men electing active surveillance. However, the extent to which mpMRI has been implemented in active surveillance has not been established.METHODS Using Surveillance, Epidemiology, and End Results registry data linked to Medicare claims data, we identified men with localized prostate cancer diagnosed between 2008 and 2013 and managed with active surveillance. We classified men into 2 treatment groups: active surveillance without mpMRI and active surveillance with mpMRI. We then fit a multivariable logistic regression models to examine changing mpMRI utilization over time, and factors associated with the receipt of mpMRI.RESULTS We identified 9467 men on active surveillance. Of these, 8178 (86%) did not receive mpMRI and 1289 (14%) received mpMRI. The likelihood of receiving mpMRI over the entire study period increased by 3.7% (P = .004). On multivariable logistic regression, patients who were younger, white, had lower comorbidity burden, lived in the northeast and west, had higher incomes and lived in more urban areas had greater odds of receiving mpMRI (all P < .05).CONCLUSION From 2008 to 2013, use of mpMRI in active surveillance increased gradually but significantly. Receipt of mpMRI among men on surveillance for prostate cancer varied significantly across demographic, geographic, and socioeconomic strata. Going forward, studies should investigate causes for this variation and define ideal strategies for equitable, cost-effective dissemination of mpMRI technology. (C) 2019 Elsevier Inc.