Questioning the 10-year Life Expectancy Rule for High-grade Prostate Cancer: Comparative Effectiveness of Aggressive vs Nonaggressive Treatment of High-grade Disease in Older Men With Differing Comorbid Disease Burdens
Questioning the 10-year Life Expectancy Rule for High-grade Prostate Cancer: Comparative Effectiveness of Aggressive vs Nonaggressive Treatment of High-grade Disease in Older Men With Differing Comorbid Disease Burdens
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DOI：
10.1016/j.urology.2016.02.057
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发表时间：
2016-07-01
期刊：
影响因子：
2.1
通讯作者：
Saigal, Christopher
中科院分区：
文献类型：
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作者：
Daskivich, Timothy J.;Lai, Julie;Saigal, Christopher
目的：为了确定10年规则是否适用于高级别、临床局限性前列腺癌患者，我们描述了积极治疗的生存益处。（手术、放疗、近距离放射治疗）优于非侵袭性治疗（观察等待，积极监测）诊断时患有不同合并症的老年男性。方法我们对44，521名患有cT 1 - 2的65岁以上男性进行了抽样，1991 - 2007年诊断的低分化前列腺癌，来自监测、流行病学和最终结果-医疗保险数据库。我们使用倾向调整的竞争风险回归来计算合并症亚组中积极治疗和非积极治疗的患者的5年和10年癌症死亡率。我们确定了5年和10年癌症死亡率的绝对风险降低，以及10年内预防一例癌症死亡所需的治疗人数。结果在倾向调整的竞争风险回归分析中，对于Charlson评分为0的患者，积极治疗与癌症死亡率的显著降低相关（亚危害比（SHR）0.43，95%置信区间[CI] 0.39 - 0.47），1（SHR 0.48，95% CI 0.40 - 0.58）和2（SHR 0.46，95% CI 0.34 - 0.62），但不是3+（SHR 0.68，95% CI 0.44 - 1.07）。对于Charlson评分为0、1、2和3+的男性，5年时积极治疗和非积极治疗的癌症死亡率的绝对降低分别为7%、5.5%、6.9%和2.5%，10年时分别为11.3%、7.9%、8.6%和2.8%;在10年内预防1例癌症死亡所需治疗的人数分别为9、13、12和36例。结论10年规则可能不适用于高级别、临床局限性疾病的男性。Charlson评分的老年男性
OBJECTIVE To determine if the 10-year rule should apply to men with high-grade, clincially localized prostate cancer, we characterized the survival benefits of aggressive (surgery, radiation, brachytherapy) over nonaggressive treatment (watchful waiting, active surveillance) among older men with differing comorbidity at diagnosis.METHODS We sampled 44,521 men older than 65 with cT1-2, poorly differentiated prostate cancer diagnosed in 1991-2007 from the Surveillance, Epidemiology, and End Results-Medicare database. We used propensity-adjusted, competing-risks regression to calculate 5- and 10-year cancer mortality among those treated aggressively and nonaggressively across comorbidity subgroups. We determined 5- and 10-year absolute risk reduction in cancer mortality and numbers needed to treat to prevent one cancer death at 10 years.RESULTS In propensity-adjusted, competing-risks regression analysis, aggressive treatment was associated with significantly lower risk of cancer mortality for those with Charlson scores of 0 (sub-hazard ratio (SHR) 0.43, 95% confidence interval [CI] 0.39-0.47), 1 (SHR 0.48, 95% CI 0.40-0.58), and 2 (SHR 0.46, 95% CI 0.34-0.62) but not 3+ (SHR 0.68, 95% CI 0.44-1.07). Absolute reductions in cancer mortality between those treated aggressively and nonaggressively were 7%, 5.5%, 6.9%, and 2.5% at 5 years, and 11.3%, 7.9%, 8.6%, and 2.8% at 10 years for men with Charlson scores of 0, 1, 2, and 3+, respectively; numbers needed to treat to prevent 1 cancer death at 10 years were 9, 13, 12, and 36 men.CONCLUSION The 10-year rule may not apply to men with high-grade, clinically localized disease. Older men with Charlson scores