Time Trends and Local Variation in Primary Treatment of Localized Prostate Cancer
Time Trends and Local Variation in Primary Treatment of Localized Prostate Cancer
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DOI：
10.1200/jco.2009.26.0133
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发表时间：
2010-03-01
影响因子：
45.3
通讯作者：
Carroll, Peter R.
中科院分区：
文献类型：
--
作者：
Cooperberg, Matthew R.;Broering, Jeanette M.;Carroll, Peter R.
PurposeIn缺乏高水平的证据或临床指南支持任何给定的积极治疗方法超过另一个局部前列腺癌，临床医生和患者的喜好可能会导致治疗使用的实质性变化。MethodsData进行了分析，从36个临床网站，贡献数据的前列腺癌战略泌尿研究奋进（CaPSURE）注册。随时间推移测量主要治疗使用的分布。使用D 'Amico风险组和前列腺癌风险评估（CAPRA）评分评估前列腺癌风险。进行描述性分析，并建立一个分层模型，控制年的诊断，癌症风险变量，和其他患者因素，以估计的比例变化，在主要治疗选择可解释的实践site.ResultsAmong 11,892人分析，6.8%选择监测，49.9%切除术，11.6%外束放射，13.3%近距离放射治疗，4.0%冷冻消融，14.4%雄激素剥夺单药治疗。前列腺癌风险驱动治疗选择，但数据表明低风险疾病的过度治疗和高风险疾病的治疗不足。随着时间的推移，前一种趋势似乎正在改善，而后一种趋势正在恶化。治疗因年龄、合并症和社会经济地位而异。然而，不同临床试验机构的治疗模式存在显著差异，这种差异无法通过病例组合变异性或已知患者因素来解释。实践网站解释了这种变化的比例范围从13%的雄激素剥夺单药治疗到74%的cryoablation.ConclusionSubstantial变化存在于本地化的前列腺癌的管理是不能解释的可测量的因素。迫切需要对局限性前列腺癌进行高质量的比较有效性研究，以帮助指导治疗决策。J Clin Oncol 28：1117-1123. (C)2010年美国临床肿瘤学会
PurposeIn the absence of high-level evidence or clinical guidelines supporting any given active treatment approach over another for localized prostate cancer, clinician and patient preferences may lead to substantial variation in treatment use.MethodsData were analyzed from 36 clinical sites that contributed data to the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry. Distribution of primary treatment use was measured over time. Prostate cancer risk was assessed using the D'Amico risk groups and the Cancer of the Prostate Risk Assessment (CAPRA) score. Descriptive analyses were performed, and a hierarchical model was constructed that controlled for year of diagnosis, cancer risk variables, and other patient factors to estimate the proportion of variation in primary treatment selection explicable by practice site.ResultsAmong 11,892 men analyzed, 6.8% elected surveillance, 49.9% prostatectomy, 11.6% external-beam radiation, 13.3% brachytherapy, 4.0% cryoablation, and 14.4% androgen deprivation monotherapy. Prostate cancer risk drives treatment selection, but the data suggest both overtreatment of low-risk disease and undertreatment of high-risk disease. The former trend appears to be improving over time, while the latter is worsening. Treatment varies with age, comorbidity, and socioeconomic status. However, treatment patterns vary markedly across clinical sites, and this variation is not explained by case-mix variability or known patient factors. Practice site explains a proportion of this variation ranging from 13% for androgen deprivation monotherapy to 74% for cryoablation.ConclusionSubstantial variation exists in management of localized prostate cancer that is not explained by measurable factors. A critical need exists for high-quality comparative effectiveness research in localized prostate cancer to help guide treatment decision making. J Clin Oncol 28: 1117-1123. (C) 2010 by American Society of Clinical Oncology