Toward better use of bone scans among men with early-stage prostate cancer.
Toward better use of bone scans among men with early-stage prostate cancer.
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DOI：
10.1016/j.urology.2014.06.010
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发表时间：
2014-10
期刊：
影响因子：
2.1
通讯作者：
Denton BT
中科院分区：
文献类型：
--
作者：
Merdan S;Womble PR;Miller DC;Barnett C;Ye Z;Linsell SM;Montie JE;Denton BT
评价已发表的指南与现行实践在新诊断前列腺癌男性放射学分期方面的性能。使用密歇根泌尿外科改进合作（MUSIC）临床登记处的数据，我们确定了2012年3月至2013年6月期间诊断为前列腺癌的1，509名男性。临床资料包括年龄、前列腺特异性抗原（PSA）、Gleason评分（GS）、临床T分期、活检针数和骨扫描（BS）结果。然后，我们拟合多变量逻辑回归模型，以检查临床变量和骨转移发生之间的关联。由于有些患者没有接受BS，我们使用已建立的方法来纠正验证偏倚，并估计已发表指南的诊断准确性。在接受BS的416名男性中，48名（11.5%）有骨转移的证据。骨转移患者年龄较大，PSA和GS较高（均p <0.05）。在多变量分析中，PSA（p <0.001）和GS（p =0.004）是BS阳性的唯一独立预测因素。美国泌尿外科协会（AUA）和国家综合癌症网络（NCCN）的指南在检测我们人群的骨转移方面表现出相似的性能，阴性研究少于欧洲泌尿外科协会（EAU）指南。应用AUA建议（即，当PSA >20或GS ≥8时成像）与当前临床实践相比，我们估计<1%的阳性研究将被遗漏，而阴性研究的数量将减少38%。根据目前的实践模式，更统一地应用现有指南将确保几乎所有骨转移男性都进行BS，同时避免许多阴性影像学研究。
To evaluate the performance of published guidelines compared to current practice for radiographic staging of men with newly-diagnosed prostate cancer. Using data from the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry, we identified 1,509 men diagnosed with prostate cancer from March 2012 through June 2013. Clinical data included age, prostate-specific antigen (PSA), Gleason score (GS), clinical T-stage, number of biopsy cores and bone scan (BS) results. We then fit a multivariable logistic regression model to examine the association between clinical variables and the occurrence of bone metastases. Because some patients did not undergo BS, we used established methods to correct for verification bias and estimate the diagnostic accuracy of published guidelines. Among 416 men who received a BS, 48 (11.5%) had evidence of bone metastases. Patients with bone metastases were older, with higher PSA and GS (all p <0.05). In multivariable analyses, PSA (p <0.001) and GS (p =0.004) were the only independent predictors of positive BS. Guidelines from the American Urology Association (AUA) and the National Comprehensive Cancer Network (NCCN) demonstrated similar performance in detecting bone metastases in our population, with fewer negative studies than the European Association of Urology (EAU) guideline. Applying the AUA recommendations (i.e., image when PSA >20 or GS ≥8) to current clinical practice, we estimate that <1% of positive studies would be missed, while the number of negative studies would be reduced by 38%. Based on current practice patterns, more uniform application of existing guidelines would ensure that BS is performed for almost all men with bone metastases, while avoiding many negative imaging studies.