Marriage and ethnicity predict treatment in localized prostate carcinoma
Marriage and ethnicity predict treatment in localized prostate carcinoma
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DOI：
10.1002/cncr.20982
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发表时间：
2005-05-01
期刊：
影响因子：
6.2
通讯作者：
Steiner, JF
中科院分区：
文献类型：
--
作者：
Denberg, TD;Beaty, BL;Steiner, JF
背景，早期前列腺癌的主要治疗包括期待治疗，或者为了治愈目的，进行根治性前列腺切除术或放射治疗。治疗建议通常以临床因素为指导，例如格里森分级、前列腺特异性抗原水平、合并症和患者年龄。社会文化因素也可能影响患者和泌尿科医生的治疗选择。方法。作者使用双变量和多项 Logistic 回归，在最新关联的监测、流行病学和最终结果-医疗保险数据集（1995-1999 年）中，在 27,920 名无合并症的非拉丁裔白人、黑人和拉丁裔男性队列中，确定了前列腺切除术（与放疗相比）和治愈性治疗（与期待治疗相比）的医学和社会人口学预测因子。预测因素包括肿瘤分期、患者年龄、婚姻状况、种族/民族和社会经济状况。 结果。与期待治疗相比，年轻的年龄和较高的肿瘤分级是治愈性治疗的强有力的预测因素，与放疗相比，是前列腺切除术的强有力的预测因素。社会人口因素在治疗选择中具有附加作用。婚姻预测 治愈性治疗与期待治疗相比（调整后的风险比 [RR] 1.28 [1.25-1.30]），前列腺切除术与放疗相比（调整后的 RR 1.24 [1.20-1.28]）。尽管黑人和拉丁裔接受治疗的可能性与白人一样，但与放疗相比，黑人接受前列腺切除术的可能性明显较低，而拉丁裔则更有可能接受前列腺切除术（调整后的 RR 分别为 0.77 [0.72-83]）和 1.24 [1.18-1.30]。结论。一般来说，婚姻与治疗呈正相关，特别是与前列腺切除术呈正相关。黑人接受前列腺切除术的频率低于白人，尽管他们总体上接受的治疗效果并不差。拉丁裔比白人更常接受前列腺切除术。临床医生应该认识到文化和社会力量以及生物医学因素在早期前列腺癌患者治疗决策中的重要性。 (c) 2005 年美国癌症协会。
BACKGROUND, Primary treatment for early-stage prostate carcinoma includes expectant management or, for curative intent, radical prostatectomy or radiotherapy. Treatment recommendations are generally guided by clinical factors such as Gleason grade, prostate-specific antigen level, comorbid illnesses, and patient age. Sociocultural factors may also have influences on patient and urologist treatment choices.METHODS. The authors used bivariate and multinomial logistic regression to identify medical and sociodemographic predictors of prostatectomy (compared with radiotherapy) and curative therapy (compared with expectant management) in a cohort of 27,920 non-Latino white, black, and Latino men without comorbidities in the latest linked Surveillance, Epidemiology and End Results-Medicare dataset (years 1995-1999). Predictors included tumor stage, patient age, marital status, race/ethnicity, and soscioeconomic status.RESULTS. Younger age and higher tumor grade were robust predictors of curative treatment compared with expectant management and of prostatectomy compared with radiotherapy. Sociodemographic factors had an additive role in treatment choice. Marriage predicted Curative treatment compared with expectant management (adjusted risk ratio [RR] 1.28 [1.25-1.30]) and prostatectomy compared with radiotherapy (adjusted RR 1.24 [1.20-1.28]). Although blacks and Latinos were just as likely as whites to receive curative treatment, blacks were significantly less likely, whereas Latinos were more likely, to receive prostatectomy compared with radiotherapy (adjusted RRs = 0.77 [0.72-83]) and 1.24 [1.18-1.30], respectively).CONCLUSIONS. Marriage was positively associated with curative treatment in general, and with prostatectomy specifically. Blacks received prostatectomy less often than whites, although they did not receive less curative treatment overall. Latinos received prostatectomy more often than whites. Clinicians should recognize the importance of cultural and social forces as well as biomedical factors in decisions regarding the treatment of patients with early-stage prostate carcinoma. (c) 2005 American Cancer Society.