Evolving Landscape of Practice Patterns in the Management of Localized Low-Risk Prostate Cancer: A NCDB Study

Author:

Mao Shifeng1,Samiei Arash2,Yin Yue3,Schorr Rebecca4,Wegner Rodney E.5,Fuhrer Russell5,Lyne John2,Sanguino Angela6,Miller Ralph2,Cohen Jeffrey2

Affiliation:

1. Division of Medical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania

2. Division of Urology, Allegheny Health Network, Pittsburgh, Pennsylvania

3. Allegheny-Singer Research Institute, Allegheny Health Network, Pittsburgh, Pennsylvania

4. Highmark Health, Care Analytics, Pittsburgh, Pennsylvania

5. Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania

6. Department of Pathology, Allegheny Health Network, Pittsburgh, Pennsylvania

Abstract

Introduction: Most patients with low-risk prostate cancer (LRPC) are candidates for active surveillance (AS) or definitive local treatment, including radical prostatectomy (RP), external beam radiotherapy (EBRT), or prostate seed implant (PSI). In this study, we analyzed the treatment pattern of patients with LRPC using a large patient population provided by the National Cancer Database (NCDB). Methods: Patients with LRPC, as defined by the National Comprehensive Cancer Network criteria, between 2004 and 2015 from the NCDB were analyzed. Patients, with no or minimal comorbidity, were categorized according to treatment modalities, including RP, EBRT, PSI, and no local therapy (NLT). Chi-square tests were used to analyze the association among demographic variables and treatments. Multivariate logistic regression analyses were conducted to determine the likelihood of choosing NLT. Results: In total, 195,452 patients diagnosed with LRPC between 2004 and 2015 were identified. There was a significant change in practice patterns with increased utilization of NLT over time, from 11.3% in 2004 to 53.5% in 2015, with a turning point in 2009. RP utilization peaked at 41.6% in 2008, EBRT peaked at 24.3% in 2006, and PSI peaked at 35.3% in 2004. However, it dropped to 17.6%, 18.1%, and 10.8%, respectively, in 2015. Academic/research programs (A/RP), older age, lower income, poorer education, lack of insurance, African Americans, and other races were associated with increased NLT use. The difference between White and African American, and older and younger patients in odds ratios were less after 2010. Conclusions: There was a significant shift in treatment patterns between 2004 and 2015. AS, as represented by the NLT in this study, has become the dominant treatment of choice for patients with LRPC. A/RPs were leading this trend, particularly in younger patients. Socioeconomic factors played roles in choosing NLT, but the racial difference became less apparent after 2010.

Publisher

Ovid Technologies (Wolters Kluwer Health)

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3