The effect of selection and referral biases for the treatment of localised prostate cancer with surgery or radiation
The effect of selection and referral biases for the treatment of localised prostate cancer with surgery or radiation
复制标题
选择和转诊偏差对手术或放射治疗局限性前列腺癌的影响
作者：
C. Wallis;G. Morton;S. Herschorn;R. Kodama;G. Kulkarni;S. Appu;B. Shayegan;R. Buckley;A. Grabowski;S. Narod;R. Nam
对于诊断为前列腺癌的患者，除了泌尿科医生外，还应咨询放射肿瘤科医生。除了泌尿科医生外，接受放射肿瘤科医生咨询的患者的治疗模式以前没有描述过。我们对加拿大安大略新诊断的非转移性前列腺癌男性进行了一项匹配队列研究。根据肿瘤和患者特征，将治疗前接受放射肿瘤科医生咨询的患者与仅由泌尿科医生治疗的患者1：1匹配。我们检查了诊断后一年内积极治疗（手术或放疗）的比率。在5708对匹配的配对中（11，416名患者），接受放射肿瘤学咨询的患者更有可能接受积极治疗，无论他们是否患有中度或高危疾病（88.6% vs. 65.9%，p < 0.0001;校正比值比4.0，95% CI：3.6-4.4）或低风险疾病（56.1% vs. 13.3%，p < 0.0001;校正比值比8.4，95% CI：6.7-10.6）。在考虑了年龄、合并症、肿瘤体积和诊断年份后，这种影响仍然存在。与仅由泌尿科医生治疗的患者相比，接受放射肿瘤学咨询的新诊断前列腺癌患者的积极治疗率更高。选择和转诊偏倚，以及未测量的混杂因素，如患者偏好，必须被认为是导致这种关联的重要因素。
Consultation with radiation oncologists, in addition to urologists, is advocated for patients diagnosed with prostate cancer. Treatment patterns for patients receiving consultation from radiation oncologists in addition to urologists have not previously been described. We conducted a matched cohort study of men with newly diagnosed non-metastatic prostate cancer in Ontario, Canada. Patients who underwent consultation with a radiation oncologist prior to treatment were matched 1:1 with patients managed by a urologist alone based on tumour and patient characteristics. We examined rates of active treatment (surgery or radiotherapy) within one year following diagnosis. Among 5708 matched pairs (11,416 patients), those who received radiation oncology consultation were more likely to undergo active treatments whether they had intermediate or high-risk disease (88.6% vs. 65.9%, p < 0.0001; adjusted odds ratio 4.0, 95% CI: 3.6–4.4) or low-risk disease (56.1% vs. 13.3%, p < 0.0001; adjusted odds ratio 8.4, 95% CI: 6.7–10.6). This effect persisted after considering age, comorbidity, tumour volume and year of diagnosis. Patients newly diagnosed with prostate cancer who receive radiation oncology consultation are associated with a higher rate of active treatment, compared to patients managed by urologists only. Selection and referral biases, and unmeasured confounding such as patient preference must be considered as important factors attributing this association.
DOI：
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发表时间：
2010
期刊：
Journal of the National Comprehensive Cancer Network : JNCCN
影响因子：
--
作者：
J. Mohler;R. Bahnson;B. Boston;J. E. Busby;A. D'Amico;J. Eastham;C. Enke;D. George;E. Horwitz;R. Huben;P. Kantoff;M. Kawachi;M. Kuettel;P. Lange;G. Macvicar;E. Plimack;J. Pow-Sang;M. Roach;E. Rohren;B. Roth;D. Shrieve;Matthew R. Smith;S. Srinivas;P. Twardowski;P. Walsh
通讯作者：
J. Mohler;R. Bahnson;B. Boston;J. E. Busby;A. D'Amico;J. Eastham;C. Enke;D. George;E. Horwitz;R. Huben;P. Kantoff;M. Kawachi;M. Kuettel;P. Lange;G. Macvicar;E. Plimack;J. Pow-Sang;M. Roach;E. Rohren;B. Roth;D. Shrieve;Matthew R. Smith;S. Srinivas;P. Twardowski;P. Walsh
影响因子：
28.4
作者：
Prasad,SandipM;Sartor,AOliver;Bennett,CharlesL
通讯作者：
Bennett,CharlesL