Adoption of New Risk Stratification Technologies Within US Hospital Referral Regions and Association With Prostate Cancer Management.
Adoption of New Risk Stratification Technologies Within US Hospital Referral Regions and Association With Prostate Cancer Management.
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DOI：
10.1001/jamanetworkopen.2021.28646
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发表时间：
2021-10-01
影响因子：
13.8
通讯作者：
Gross CP
中科院分区：
文献类型：
--
作者：
Leapman MS;Wang R;Park HS;Yu JB;Sprenkle PC;Dinan MA;Ma X;Gross CP
采用前列腺磁共振成像(MRI)和基因组检测是否与前列腺癌更多地使用观察而不是积极治疗有关？在这项对65 530名有商业保险的前列腺癌患者进行的队列研究中，前列腺癌MRI的摄取和基因组检测与作为初始治疗的观察和积极治疗的使用增加相关。尽管前列腺MRI、基因组检测和观察总体上有所增加，但不同医院转诊地区的使用情况存在很大差异。这项研究的结果表明，采用旨在改善决策的技术可能会显著减少前列腺癌的过度治疗。前列腺癌患者通过前列腺癌磁共振成像(MRI)和基因组测试做出的临床决策尚未得到很好的理解。目的：评价前列腺癌患者的前列腺癌MRI区域摄取与基因组检测、观察和治疗的关系。这项对前列腺癌核磁共振和基因组测试商业保险索赔的回顾性队列研究包括65名 530名年龄在40岁至89岁之间的新诊断为前列腺癌的患者，从2012年7月1日到2019年6月30日。患者和区域层面的前列腺核磁共振和基因组测试的使用。前列腺癌的观察与确定的治疗方法。患者水平的分析检查了接受检测或居住在采用检测和观察的医院转诊区域(HRR)之间的关联。在区域层面的分析中，因变量是在两个时期内观察到的前列腺癌患者比例的变化：2012年7月1日至2014年6月30日，以及2017年7月1日至2019年6月20日。独立的研究变量包括接受前列腺癌MRI和基因组测试的男性在这些时期的HRR水平变化，模型根据与前列腺癌护理和社会经济地位相关的背景因素进行了调整。本研究确定了65例 患者，包括27例早期 679(平均年龄58.0[5.9]岁)和37例晚期(平均59.0[5.7]岁) 851例。从早期到晚期，前列腺MRI的使用率从7.2%(95%可信区间6.9%~7.5%)上升到16.7%(95%可信区间16.3%~17.1%)。从早期到晚期，基因组检测的使用从1.3%(95%可信区间，1.1%~1.4%)上升到12.7%(95%可信区间，12.3%~13.0%)。与最低值相比，前列腺磁共振和基因组检测摄取率最高的四分位数分别与接受观察的患者比例调整后的4.1%(SE，1.1%；P <； .001)和2.5%(SE，1.1%；P = .03)的绝对值增加相关。在这项队列研究中，前列腺癌患者接受前列腺癌核磁共振成像和基因组检测的情况与前列腺癌初期观察和治疗的使用增加有关。显著的地域差异支持进一步的患者水平研究的需要，以优化检测的传播和结果。这项队列研究评估了使用前列腺癌磁共振成像和基因组检测与前列腺癌初期治疗之间的关系。
Is adoption of prostate magnetic resonance imaging (MRI) and genomic testing associated with increased use of observation rather than active treatment for prostate cancer? In this cohort study of 65 530 commercially insured patients with prostate cancer, uptake of prostate MRI and genomic testing was associated with increased use of observation vs active treatment as initial management. Although prostate MRI, genomic testing, and observation increased overall, use was highly varied across hospital referral regions. The findings of this study suggest that adoption of technologies designed to improve decision-making may lead to perceivable reductions in overtreatment of prostate cancer The clinical decisions that arise from prostate magnetic resonance imaging (MRI) and genomic testing in patients with prostate cancer are not well understood. To evaluate the association between regional uptake of prostate MRI and genomic testing and observation vs treatment for prostate cancer. This retrospective cohort study of commercial insurance claims for prostate MRI and genomic testing included 65 530 patients 40 to 89 years of age newly diagnosed with prostate cancer from July 1, 2012, through June 30, 2019. Patient- and regional-level use of prostate MRI and genomic testing. Observation vs definitive treatment for prostate cancer. Patient-level analyses examined the association between receipt of testing or residing in a hospital referral region (HRR) that adopted testing and observation. In regional-level analyses, the dependent variable was the change in the proportion of patients observed for prostate cancer at the HRR level between 2 periods: July 1, 2012, to June 30, 2014, and July 1, 2017, to June 20, 2019. The independent study variables included HRR-level changes in the proportion of men undergoing prostate MRI and genomic testing between these periods, and the models were adjusted for contextual factors associated with prostate cancer care and socioeconomic status. This study identified 65 530 patients, including 27 679 in the early period (mean [SD] age, 58.0 [5.9] years) and 37 851 in the late period (mean [SD] age, 59.0 [5.7] years). Use of prostate MRI increased significantly from 7.2% (95% CI, 6.9%-7.5%) to 16.7% (95% CI, 16.3%-17.1%) from the early to late period. Use of genomic testing increased significantly from 1.3% (95% CI, 1.1%-1.4%) to 12.7% (95% CI, 12.3%-13.0%) from the early to late period. Compared with the lowest, the highest HRR quartiles of prostate MRI and genomic testing uptake were associated with an adjusted 4.1% (SE, 1.1%; P < .001) and 2.5% (SE, 1.1%; P = .03) absolute increase in the proportion of patients receiving observation, respectively. In this cohort study, uptake of prostate MRI and genomic testing was associated with increased use of initial observation vs treatment for prostate cancer. Marked geographic variation supports the need for further patient-level research to optimize the dissemination and outcome of testing. This cohort study assesses the association between the use of prostate magnetic resonance imaging and genomic testing and the initial management of prostate cancer.
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乳腺癌外科医生同伴网络特征和新成像技术的采用：围手术期 MRI 的研究。
影响因子：
4
作者：
Tannenbaum SS;Soulos PR;Herrin J;Pollack CE;Xu X;Christakis NA;Forman HP;Yu JB;Killelea BK;Wang SY;Gross CP
通讯作者：
Gross CP
影响因子：
3.7
作者：
Kim, Simon P.;Gross, Cary P.;Meropol, Neal J.
通讯作者：
Meropol, Neal J.
影响因子：
28.4
作者：
Makarov, Danil V.;Soulos, Pamela R.;Gross, Cary P.
通讯作者：
Gross, Cary P.
DOI：
10.1056/nejmoa1801993
发表时间：
2018-05-10
期刊：
The New England journal of medicine
影响因子：
--
作者：
通讯作者：
--
影响因子：
23.4
作者：
Cooperberg, Matthew R.;Davicioni, Elai;Crisan, Anamaria;Jenkins, Robert B.;Ghadessi, Mercedeh;Karnes, R. Jeffrey
通讯作者：
Karnes, R. Jeffrey