Patterns and Correlates of Prostate Cancer Treatment in Older Men
Patterns and Correlates of Prostate Cancer Treatment in Older Men
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DOI：
10.1016/j.amjmed.2010.10.016
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发表时间：
2011-03-01
影响因子：
5.9
通讯作者：
Lu-Yao, Grace L.
中科院分区：
文献类型：
--
作者：
Roberts, Calpurnyia B.;Albertsen, Peter C.;Lu-Yao, Grace L.
背景技术背景：尽管老年男性，特别是低风险前列腺癌患者和预期寿命不到10年的患者，不太可能从前列腺癌积极治疗中获益，但这一群体的治疗率很高。通过使用与2004年至2005年医疗保险数据相关的基于人口的监测、流行病学和最终结果计划，我们研究了临床和非临床因素对前列腺癌积极治疗选择的影响（即根治性直肠癌切除术、体外放射治疗、近距离放射治疗，或雄激素剥夺疗法）治疗年龄≥ 75岁的新诊断为局限性前列腺癌的男性。多变量逻辑回归用于估计接受前列腺癌积极治疗的优势比（OR）和95%置信区间（CI）。结果：大多数年龄≥ 75岁的男性接受前列腺癌积极治疗（81.7%），其根据疾病风险水平而变化：低，72.2%;中等，83.7%;和高，86.4%。总体而言，在老年男性中，前列腺癌积极治疗的总方差百分比归因于临床和非临床因素是最小的，分别为5.1%和2.6%。在低风险疾病男性中，合并症状态不影响治疗选择，因此，合并症为1或2+的患者与健康男性一样可能接受前列腺癌积极治疗：OR = 0.98; 95%CI，0.76-1.27和OR = 1.19; 95%CI，0.84-1.68。地理位置是治疗选择的最有力预测因素（东北部vs大加州：OR = 2.41; 95%CI，1.75-3.32）。结论：临床因素在老年局限性前列腺癌患者治疗选择中的作用有限。(C)2011 Elsevier Inc. All rights reserved. .美国医学杂志（2011）124，235-243
BACKGROUND: Although elderly men, particularly patients with low-risk prostate cancer and a life expectancy less than 10 years, are unlikely to benefit from prostate cancer active therapy, treatment rates in this group are high.METHODS: By using the population-based Surveillance, Epidemiology, and End Results program linked to Medicare data from 2004 to 2005, we examined the effects of clinical and nonclinical factors on the selection of prostate cancer active therapy (ie, radical prostatectomy, external beam radiation therapy, brachytherapy, or androgen deprivation therapy) in men aged >= 75 years with a new diagnosis of localized prostate cancer. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for receiving prostate cancer active therapy.RESULTS: The majority of men aged >= 75 years were treated with prostate cancer active therapy (81.7%), which varied by disease risk level: low, 72.2%; intermediate, 83.7%; and high, 86.4%. Overall, in older men, the percentage of the total variance in the use of prostate cancer active therapy attributable to clinical and nonclinical factors was minimal, 5.1% and 2.6%, respectively. In men with low-risk disease, comorbidity status did not affect treatment selection, such that patients with 1 or 2+ comorbidities were as likely to receive prostate cancer active therapy as healthy men: OR = 0.98; 95% CI, 0.76-1.27 and OR = 1.19; 95% CI, 0.84-1.68, respectively. Geographic location was the most powerful predictor of treatment selection (Northeast vs Greater California: OR = 2.41; 95% CI, 1.75-3.32).CONCLUSION: Clinical factors play a limited role in treatment selection among elderly patients with localized prostate cancer. (C) 2011 Elsevier Inc. All rights reserved. . The American Journal of Medicine (2011) 124, 235-243