The Population Level Prevalence and Correlates of Appropriate and Inappropriate Imaging to Stage Incident Prostate Cancer in the Medicare Population
The Population Level Prevalence and Correlates of Appropriate and Inappropriate Imaging to Stage Incident Prostate Cancer in the Medicare Population
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DOI：
10.1016/j.juro.2011.09.042
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发表时间：
2012-01-01
影响因子：
6.6
通讯作者：
Gross, Cary P.
中科院分区：
文献类型：
--
作者：
Makarov, Danil V.;Desai, Rani A.;Gross, Cary P.
目的：根据指南，大多数男性前列腺癌患者不需要分期影像学检查。我们确定了该队列中人群水平的患病率以及适当和不适当影像学检查的相关性。材料和方法：我们对2004年和2005年从SEER（监测、流行病学和最终结果）-Medicare数据库中诊断为前列腺癌的66至85岁男性进行了一项横断面研究。分为低危组（无前列腺特异性抗原大于10 ng/ml， Gleason评分大于7分或临床分期大于T2）和高危组（上述1项及以上）。不适当的成像定义为对低风险男性的任何成像，适当的成像定义为对高风险男性的骨扫描以及适当的盆腔成像。Logistic回归对各组影像进行建模。结果：在18491名低危男性中，45%接受了不适当的影像学检查，而在10562名高危男性中，只有66%接受了适当的影像学检查。对于低风险的患者，不适当的影像学检查与临床分期增加（T2对T1 OR 1.35, 95% CI 1.27-1.44）、较高的Gleason评分（7对小于7 OR 1.80, 95% CI 1.69-1.92）、年龄和合病增加以及教育程度降低相关。对高危男性进行适当的影像学检查与分期较低（T4、T3和T2 vs T1 OR 0.63, 95% CI 0.48-0.82, OR 0.67, 95% CI 0.60-0.80和OR 0.87, 95% CI 0.80-0.86）和较高的Gleason评分（大于8和7 vs小于7 OR 2.18, 95% CI 1.92-2.48和1.51,95% CI 1.35-1.70）以及年龄较小、白人、高收入、分期较低和合并症较多相关。结论：我们发现前列腺癌患者对影像学指南的依从性较差。了解临床医生使用前列腺癌成像的模式应该指导教育工作和研究，以提出基于证据的指南改进。
Purpose: According to guidelines most men with incident prostate cancer do not require staging imaging. We determined the population level prevalence and correlates of appropriate and inappropriate imaging in this cohort.Materials and Methods: We performed a cross-sectional study of men 66 to 85 years old who were diagnosed with prostate cancer in 2004 and 2005 from the SEER (Surveillance, Epidemiology and End Results)-Medicare database. Low risk (no prostate specific antigen greater than 10 ng/ml, Gleason score greater than 7 or clinical stage greater than T2) and high risk (1 or more of those features) groups were formed. Inappropriate imaging was defined as any imaging for men at low risk and appropriate imaging was defined as bone scan for men at high risk as well as pelvic imaging as appropriate. Logistic regression modeled imaging in each group.Results: Of 18,491 men at low risk 45% received inappropriate imaging while only 66% of 10,562 at high risk received appropriate imaging. For patients at low risk inappropriate imaging was associated with increasing clinical stage (T2 vs T1 OR 1.35, 95% CI 1.27-1.44), higher Gleason score (7 vs less than 7 OR 1.80, 95% CI 1.69-1.92), increasing age and comorbidity as well as decreasing education. Appropriate imaging for men at high risk was associated with lower stage (T4, T3 and T2 vs T1 OR 0.63, 95% CI 0.48-0.82, OR 0.67, 95% CI 0.60-0.80 and OR 0.87, 95% CI 0.80-0.86) and with higher Gleason score (greater than 8 and 7 vs less than 7 OR 2.18, 95% CI 1.92-2.48 and 1.51, 95% CI 1.35-1.70, respectively) as well as with younger age, white race, higher income, lower stage and more comorbidity.Conclusions: We found poor adherence to imaging guidelines for men with incident prostate cancer. Understanding the patterns by which clinicians use imaging for prostate cancer should guide educational efforts as well as research to suggest evidence-based guideline improvements.