Time trends and characteristics of men choosing watchful waiting for initial treatment of localized prostate cancer: Results from CaPSURE
Time trends and characteristics of men choosing watchful waiting for initial treatment of localized prostate cancer: Results from CaPSURE
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DOI：
10.1097/01.ju.0000091641.34674.11
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发表时间：
2003-11-01
影响因子：
6.6
通讯作者：
Carroll, PR
中科院分区：
文献类型：
--
作者：
Harlan, SR;Cooperberg, MR;Carroll, PR
目的：观察等待（WW）是临床局限性前列腺癌男性的一种选择。我们研究的时间趋势，在使用WW，以及社会人口和临床概况的男性谁选择这种形式的management.Materials和方法：前列腺癌的战略泌尿研究奋进是一个国家登记处的前列腺癌患者的各个阶段。在1989年至2000年期间，数据库中的5，365名男性被诊断患有局部疾病，并在诊断后9个月内选择了WW或积极治疗。其中402人选择WW作为初始疾病管理。我们使用卡方检验和多元逻辑回归分析了WW使用的时间趋势以及WW的社会人口统计学和临床预测因素。在检查3年间隔时，WW的使用从1989年至1991年的7.5%增加到1992年至1994年的9.5%，然后在接下来的6年中下降到1998年至2000年的5.5%（p = 0.001）。T1期前列腺特异性抗原≤ 10 ng/ml的WW患者比例随时间显著增加，与选择积极治疗的患者相比，选择WW的患者更可能患有低风险疾病。控制后的临床因素WW患者也更有可能是75岁或以上，有医疗保险，并有更大的comormality.Conclusions：在前列腺特异性抗原时代率WW的前列腺癌的初始治疗一直在下降，尽管相当大的向下阶段迁移。我们预计，随着前列腺癌风险评估和监测策略的不断改进，更多的患者可能会从这种管理方法中受益。
Purpose: Watchful waiting (WW) is one option for men with clinically localized prostate cancer. We examined temporal trends in the use of WW, as well as sociodemographic and clinical profiles of men who choose this form of management.Materials and Methods: The Cancer of the Prostate Strategic Urologic Research Endeavor is a national registry of patients with various stages of prostate cancer. Between 1989 and 2000, 5,365 men in the database were diagnosed with localized disease and elected either WW or active treatment within 9 months of diagnosis. Of these men 402 elected WW as initial disease management. We analyzed time trends in WW use, and sociodemographic and clinical predictors of WW using chi-square tests and multivariate logistical regression.Results: In examining 3-year intervals, use of WW increased from 7.5% in 1989 to 1991 to 9.5% in 1992 to 1994, and then decreased during the next 6 years to 5.5% in 1998 to 2000 (p = 0.001). With time there was a significant increase in the proportion of WW patients with T1 disease and prostate specific antigen of 10 ng/ml or less. Compared to patients choosing active treatment, patients opting for WW were more likely to have low risk disease. After controlling for clinical factors WW patients were also more likely to be 75 years old or older, to have Medicare insurance and to have greater comorbidity.Conclusions: During the prostate specific antigen era rates of WW for the initial treatment of prostate cancer have been decreasing despite considerable downward stage migration. We expect that as prostate cancer risk assessment and surveillance strategies continue to improve, more patients may benefit from this approach to management.