Treatment of locally advanced pancreatic cancer in the real world: Population-based practices and effectiveness
Treatment of locally advanced pancreatic cancer in the real world: Population-based practices and effectiveness
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DOI：
10.1200/jco.2003.03.007
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发表时间：
2003-09-15
影响因子：
45.3
通讯作者：
Earle, CC
中科院分区：
文献类型：
--
作者：
Krzyzanowska, MK;Weeks, JC;Earle, CC
目的：评估局部晚期胰腺癌（LAPC）老年患者癌症导向治疗的使用和有效性：我们使用了相关的监测、流行病学和最终结果医疗保险数据库，对1991年至1996年诊断为LAPC的1,696例患者进行了回顾性队列研究。我们计算了针对癌症的治疗使用率，然后使用逻辑回归来确定与接受治疗相关的患者和卫生系统因素。治疗的有效性估计使用考克斯比例风险模型和倾向评分methods.Results：在我们的队列中，44%的患者接受了某种形式的癌症定向治疗（24%的放射治疗与同步化疗，13%的放射治疗，7%的化疗单独）。年龄较大、社会经济地位较低、存在共病、在教学医院没有护理以及居住在美国西部与接受治疗的可能性较低相关（P <或等于0.05）。在接受治疗的患者中，年龄较小和特定的地理位置是接受综合治疗的唯一预测因素。在考克斯模型中，与任何治疗相关的死亡的校正风险比为0.53（P < .0001）。使用倾向评分方法获得的有效性估计是similar.Conclusion：这项分析支持癌症导向治疗的有效性，在老年患者LAPC，但使用率低。接受治疗与非疾病相关因素密切相关，特别是社会人口特征，这表明在获得护理方面可能存在差异。(C)2003年，美国临床肿瘤学会。
Purpose : To evaluate the use and effectiveness of cancer-directed therapy in elderly patients with locally advanced pancreatic cancer (LAPC).Methods: We used the linked Surveillance, Epidemiology, and End Results Medicare database to perform a retrospective cohort study in 1,696 patients diagnosed with LAPC between 1991 and 1996. We calculated cancer-directed treatment use rates, then used logistic regression to identify patient and health system factors that were associated with receipt of treatment. Effectiveness of treatment was estimated using Cox proportional hazards models and propensity score methods.Results: In our cohort, 44% of patients received some form of cancer-directed therapy (24% radiation with concurrent chemotherapy, 13% radiation alone, and 7% chemotherapy alone). Older age, lower socioeconomic status, presence of comorbid illness, no care in a teaching hospital, and residence in the western United States were associated with a lower likelihood of receiving treatment (P less than or equal to 0.05). Among those treated, younger age and certain geographic locations were the only predictors of receiving combined-modality therapy. The adjusted hazard ratio for death associated with any treatment in the Cox model was 0.53 (P < .0001). Effectiveness estimates obtained using propensity score methods were similar.Conclusion: This analysis supports the effectiveness of cancer-directed treatment in elderly patients with LAPC, but use is low. Receipt of treatment is strongly correlated with non-disease-related factors, especially sociodemographic characteristics, indicating possible disparities in access to care. (C) 2003 by American Society of Clinical Oncology.