Overtreatment of Men With Low-Risk Prostate Cancer and Significant Comorbidity
Overtreatment of Men With Low-Risk Prostate Cancer and Significant Comorbidity
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DOI：
10.1002/cncr.25751
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发表时间：
2011-05-15
期刊：
影响因子：
6.2
通讯作者：
Litwin, Mark S.
中科院分区：
文献类型：
--
作者：
Daskivich, Timothy J.;Chamie, Karim;Litwin, Mark S.
背景：患有低风险前列腺癌和严重合并症的男性容易受到过度治疗。作者试图比较合并症和年龄对低风险疾病男性治疗选择的影响。方法：作者在1997年至2004年期间在大洛杉矶和长滩退伍军人事务医疗中心对509名低风险前列腺癌男性进行了抽样调查。在不同年龄和具有不同Charlson合并症评分的男性中确定积极治疗（根治性乳腺癌切除术、放射治疗、近距离放射治疗）的比率。采用多变量模型来确定这两个变量在预测非侵袭性治疗中的影响，并采用考克斯比例风险分析来比较根据Charlson评分和年龄分组的其他原因死亡风险。研究结果：Charlson评分>= 3的男性在54%的病例中（56名男性中的30名）进行了积极治疗，而诊断时年龄> 75岁的男性在16%的病例中（44名男性中的7名）进行了积极治疗。在多变量分析中，年龄> 75岁是非侵袭性治疗的更强预测因素（相对风险，12.0; 95%可信区间[CI]，5.4-28.3），而Charlson评分>= 3（相对风险，2.0; 95% CI，1.3-2.9）。在生存分析中，Charlson评分>= 3的男性风险增加8倍（风险比，8.4; 95%CI，4.2-16.6）和70%的10年其他原因死亡概率，而年龄> 75岁与5倍增加的风险相关（风险比，4.9; 95%CI，1.7-13.8）和24%的其他原因死亡的概率。结论：有显著合并症的男性常因低风险前列腺癌而过度治疗。与高龄患者一样，严重的合并症应该是低危男性患者积极治疗的强烈相对禁忌症。Cancer 2011; 117：2058-66. (C)2010美国癌症协会
BACKGROUND: Men with low-risk prostate cancer and significant comorbidity are susceptible to overtreatment. The authors sought to compare the impact of comorbidity and age on treatment choice in men with low-risk disease. METHODS: The authors sampled 509 men with low-risk prostate cancer diagnosed at the Greater Los Angeles and Long Beach Veterans Affairs Medical Centers between 1997 and 2004. Rates of aggressive treatment (radical prostatectomy, radiation therapy, brachytherapy) were determined among men of different ages and with different Charlson comorbidity scores. Multivariate modeling was used to determine the influence of both variables in predicting nonaggressive treatment, and Cox proportional hazards analysis was used to compare the risk of other-cause mortality among groups according to Charlson score and age. RESULTS: Men with Charlson scores >= 3 were treated aggressively in 54% of cases (30 of 56 men), while men aged > 75 years at diagnosis were treated aggressively in 16% of cases (7 of 44 men). In multivariate analysis, age > 75 years was a much stronger predictor of nonaggressive treatment (relative risk, 12.0; 95% confidence interval [CI], 5.4-28.3) than a Charlson score >= 3 (relative risk, 2.0; 95% CI, 1.3-2.9). In survival analysis, men with Charlson scores >= 3 had an 8-fold increased risk (hazard ratio, 8.4; 95% CI, 4.2-16.6) and 70% probability of other-cause mortality at 10 years, whereas age > 75 years was associated with a 5-fold increased risk (hazard ratio, 4.9; 95% CI, 1.7-13.8) and a 24% probability of other-cause mortality. CONCLUSIONS: Men with significant comorbidity often were overtreated for low-risk prostate cancer. Like advanced age, significant comorbidity should be a strong relative contraindication to aggressive treatment in men with low-risk disease. Cancer 2011; 117: 2058-66. (C) 2010 American Cancer Society.