Trends in initial management of prostate cancer in New Hampshire
Trends in initial management of prostate cancer in New Hampshire
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DOI：
10.1007/s10552-015-0574-8
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发表时间：
2015-06-01
影响因子：
2.3
通讯作者：
Hyams, Elias S.
中科院分区：
文献类型：
--
作者：
Ingimarsson, Johann P.;Celaya, Maria O.;Hyams, Elias S.
前列腺癌管理策略随着对该疾病的了解不断发展。具体而言，有新的证据表明，“低风险”癌症最好通过观察进行治疗，而局部“高风险”癌症需要积极的治疗性治疗。在这项研究中，我们评估了新罕布什尔州前列腺癌管理的趋势，以确定对循证实践的依从性。从新罕布什尔州癌症登记处，2004-2011年诊断出的临床局限性前列腺癌病例根据D 'Amico标准进行识别和分类。初始治疗方式记录为手术、放射治疗、期待治疗或激素治疗。在6，203例符合纳入标准的临床局限性前列腺癌中，分别有34%、30%和28%为低、中、高危疾病。对于低风险疾病，期待治疗（17- 42%，p < 0.001）和手术（29- 39%，p < 0.001）的使用增加，而放射治疗的使用减少（49- 19%，p < 0.001）。对于中危疾病，手术的使用增加（24- 50%，p < 0.001），而放射治疗减少（58- 34%，p < 0.001）。单独的激素治疗很少用于低风险和中风险疾病。对于高危患者，手术增加（38- 47%，p = 0.003）和放射治疗减少（41- 38%，p = 0.026），而激素治疗和期待治疗保持稳定。在新罕布什尔州，临床局限性前列腺癌的治疗出现了令人鼓舞的趋势，包括低风险癌症的积极治疗和高风险疾病的手术治疗增加。
Prostate cancer management strategies are evolving with increased understanding of the disease. Specifically, there is emerging evidence that "low-risk" cancer is best treated with observation, while localized "high-risk" cancer requires aggressive curative therapy. In this study, we evaluated trends in management of prostate cancer in New Hampshire to determine adherence to evidence-based practice.From the New Hampshire State Cancer Registry, cases of clinically localized prostate cancer diagnosed in 2004-2011 were identified and classified according to D'Amico criteria. Initial treatment modality was recorded as surgery, radiation therapy, expectant management, or hormone therapy. Temporal trends were assessed by Chi-square for trend.Of 6,203 clinically localized prostate cancers meeting inclusion criteria, 34, 30, and 28 % were low-, intermediate-, and high-risk disease, respectively. For low-risk disease, use of expectant management (17-42 %, p < 0.001) and surgery (29-39 %, p < 0.001) increased, while use of radiation therapy decreased (49-19 %, p < 0.001). For intermediate-risk disease, use of surgery increased (24-50 %, p < 0.001), while radiation decreased (58-34 %, p < 0.001). Hormonal therapy alone was rarely used for low- and intermediate-risk disease. For high-risk patients, surgery increased (38-47 %, p = 0.003) and radiation decreased (41-38 %, p = 0.026), while hormonal therapy and expectant management remained stable.There are encouraging trends in the management of clinically localized prostate cancer in New Hampshire, including less aggressive treatment of low-risk cancer and increasing surgical treatment of high-risk disease.