Incidence of initial local therapy among men with lower-risk prostate cancer in the United States
Incidence of initial local therapy among men with lower-risk prostate cancer in the United States
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DOI：
10.1093/jnci/djj308
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发表时间：
2006-08-16
影响因子：
10.3
通讯作者：
Wei, John T.
中科院分区：
文献类型：
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作者：
Miller, David C.;Gruber, Stephen B.;Wei, John T.
背景资料。在老年男性和患有低或中等级别肿瘤的男性中，早期前列腺癌往往不会带来痛苦，而且根治性前列腺癌切除术的生存益处主要是65岁以下的男性，这引发了人们对前列腺癌过度治疗的担忧。方法：使用13个监测、流行病学和最终结果登记的数据，我们对2000年至2002年间被诊断为局限性或区域性前列腺癌的71602名男性进行了回顾性队列研究。我们量化了低风险癌症男性的初步治疗(即手术或放射治疗)的发生率，根据他们死于预期可控制的前列腺癌或从局部治疗中获得生存好处的有限可能性来定义。采用分层分析和多项Logistic回归模型对不同年龄段男性的绝对治愈率和相对治愈率进行量化。所有的统计检验都是双面的。结果：我们确定了24405名患有低风险前列腺癌的男性，并完成了第一个疗程的数据。其中13537人(55%)接受了初步治疗；81%的接受治疗的人接受了放射治疗。与预期治疗相比，根治性治疗的可能性在低风险年龄段之间存在显著差异(均P
Background. The frequently indolent nature of early-stage prostate cancer in older men and in men with low- or moderate-grade tumors and the demonstration that the survival benefits of radical prostatectomy are primarily among men younger than 65 years have led to concerns about prostate cancer overtreatment. Methods: Using data from 13 Surveillance, Epidemiology, and End Results registries, we performed a retrospective cohort study of 71602 men who were diagnosed with localized or regional prostate cancer between 2000 and 2002. We quantified the incidence of initial curative therapy (i.e., surgery or radiation therapy) among men with lower-risk cancers as defined by their limited likelihood of either dying from expectantly managed prostate cancer or achieving a survival benefit from local therapy. Stratified analyses and multi-nomial logistic regression models were used to quantify the absolute and relative rates of curative therapy among men in various age-grade strata. All statistical tests were two-sided. Results: We identified 24405 men with lower-risk prostate cancers and complete data for the first course of treatment. Initial curative therapy was undertaken in 13537 of these men (55%); 81% of treated men received radiation therapy. The likelihood of curative therapy, relative to expectant management, varied statistically significantly among lower-risk age-grade strata (all P