Prostate cancer imaging trends after a nationwide effort to discourage inappropriate prostate cancer imaging.
Prostate cancer imaging trends after a nationwide effort to discourage inappropriate prostate cancer imaging.
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DOI：
10.1093/jnci/djt175
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发表时间：
2013-09-04
期刊：
影响因子：
--
通讯作者：
Stattin P
中科院分区：
文献类型：
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作者：
Makarov DV;Loeb S;Ulmert D;Drevin L;Lambe M;Stattin P
减少不适当地使用成像来分期前列腺癌是一个具有挑战性的问题，最近作为医生质量报告系统的质量措施，并由美国临床肿瘤学会和美国泌尿外科协会在明智选择运动中强调。自2000年以来，瑞典国家前列腺癌登记处（NPCR）一直致力于通过向瑞典泌尿科医生传播利用数据沿着最新的成像指南，降低全国前列腺癌成像不当率。我们试图确定这一努力对前列腺癌成像率的时间和区域影响。我们在1998年至2009年NPCR诊断为前列腺癌的男性中进行了一项回顾性队列研究（n = 99 879）。我们按照临床风险类别（低、中、高）和地理区域分层，分析了随时间推移的成像使用情况。使用具有logit链接的广义线性模型检验时间趋势。36%的男性在前列腺癌诊断后6个月内接受了成像。总体而言，影像学检查的使用随着时间的推移而减少，特别是在低风险类别中，影像学检查率从45%下降到3%（P < .001），但在高风险类别中，影像学检查率也从63%下降到47%（P < .001）。尽管区域差异很大，但所有区域的前列腺癌成像在临床和统计学上（P <0.001）均显著降低。瑞典努力向临床医生提供有关前列腺癌成像使用和成像指南的数据，这与10年期间不适当成像的减少以及高危患者适当成像的略微减少有关。这些结果可能会告知目前的努力，以促进在美国和国际上的指南一致的成像。
Reducing inappropriate use of imaging to stage incident prostate cancer is a challenging problem highlighted recently as a Physician Quality Reporting System quality measure and by the American Society of Clinical Oncology and the American Urological Association in the Choosing Wisely campaign. Since 2000, the National Prostate Cancer Register (NPCR) of Sweden has led an effort to decrease national rates of inappropriate prostate cancer imaging by disseminating utilization data along with the latest imaging guidelines to urologists in Sweden. We sought to determine the temporal and regional effects of this effort on prostate cancer imaging rates. We performed a retrospective cohort study among men diagnosed with prostate cancer from the NPCR from 1998 to 2009 (n = 99 879). We analyzed imaging use over time stratified by clinical risk category (low, intermediate, high) and geographic region. Generalized linear models with a logit link were used to test for time trend. Thirty-six percent of men underwent imaging within 6 months of prostate cancer diagnosis. Overall, imaging use decreased over time, particularly in the low-risk category, among whom the imaging rate decreased from 45% to 3% (P < .001), but also in the high-risk category, among whom the rate decreased from 63% to 47% (P < .001). Despite substantial regional variation, all regions experienced clinically and statistically (P < .001) significant decreases in prostate cancer imaging. A Swedish effort to provide data on prostate cancer imaging use and imaging guidelines to clinicians was associated with a reduction in inappropriate imaging over a 10-year period, as well as slightly decreased appropriate imaging in high-risk patients. These results may inform current efforts to promote guideline-concordant imaging in the United States and internationally.