海报库PosterKeep
PO.PS01.05 · 人群科学

低危和有利中危前列腺癌患者中保守治疗的采用情况，以及保守治疗后根治性治疗的采用情况

Uptake of conservative management, and uptake of curative-intent treatment following conservative management, in low and favorable-intermediate risk prostate cancer patients

编号 2346 展板 12 时间 4/20 09:00–12:00 区域 Section 36 主讲 Isaac Allen, PhD
分会场 Epidemiology: Cancer Incidence, Mortality, Patterns, and Methodology
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作者与单位 Authors & Affiliations

Isaac Allen1, Jane Bailey Vaselkiv2, Hannah E. Guard2, Sinead Flanagan2, Hari Iyer3, Kevin Kensler4, Jaime E. Hart5, Mark A. Preston6, Andreas Pettersson7, Keyan Salari8, Edward L. Giovannucci9, Adam S. Kibel6, Lorelei A. Mucci2, Timothy Rebbeck1

1Dana-Farber Cancer Institute, Boston, MA,2Harvard T.H. Chan School of Public Health, Boston, MA,3Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,4Weill Cornell Medicine, New York, NY,5Department of Medicine, Brigham and Women's Hospital and Harvard Medical Schoo, Boston, MA,6Department of Urology, Brigham and Women's Hospital, Boston, MA,7Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,8Department of Urology, Massachusetts General Hospital, Boston, MA,9Professor of Nutrition & Epidem., Harvard TH Chan School of Public Health, Boston, MA

摘要 Abstract

中文摘要
背景 低危和有利中危前列腺癌患者符合保守治疗的条件。我们在一个由 2,872 名诊断为低危或有利中危前列腺癌的卫生专业人员组成的前瞻性队列中，估计了保守治疗采用的概率以及保守治疗后 10 年根治性治疗启动率。 方法 本研究纳入了 1986-2019 年间诊断、参与卫生专业人员随访研究的低危（分级组 1，分期 ≤cT2a，前列腺特异性抗原（PSA）<10ng/ml）和有利中危（分级组 1，分期 cT2b-cT2c 或 PSA 10-20ng/ml，或分级组 2，分期 ≤cT2a 且 PSA<10ng/ml）前列腺癌男性患者。我们使用泊松回归估计保守治疗采用情况按诊断时年龄和日历年、前列腺癌风险组以及诊断前生活方式的变异。我们使用校正致死性进展（前列腺癌死亡、转移或启动激素治疗）和其他原因死亡竞争风险的 Fine 和 Gray 模型，估计初始接受保守治疗患者的 10 年根治性治疗启动率，删失于 2022 年 12 月。我们使用 Cox 模型评估继续接受根治性治疗的变异。 结果 保守治疗的采用率为 16%（444/2872）。保守治疗在年龄较大患者（每增加 1 岁——相对风险（RR）：1.08，95% CI：1.06-1.11）、较晚日历年（每增加 1 年——RR：1.07，95% CI 1.05-1.10）以及社会经济地位较高的社区（升高 1 个标准差——RR：1.16，95% CI 1.03-1.30）中更高。有利中危前列腺癌相比低危前列腺癌的采用率较低（RR：0.47，95% CI 0.35-0.61）。在初始接受保守治疗的 444 名患者中，当校正致死性进展和其他原因死亡的竞争风险后，10 年根治性治疗发生率为 22%。如果患者诊断时更年轻（每增加 1 岁——风险比（HR）：0.96，95% CI：0.93-0.99）或有更健康的诊断后生活方式（体力活动、BMI 和吸烟的联合测量值增加 1，评分 0-3——HR：1.47，95% CI 1.01-2.15），则更可能继续接受根治性治疗。 结论 我们发现，在低危/有利中危前列腺癌患者中，诊断时年龄、诊断时日历年、前列腺癌风险组和社区层面社会经济地位会影响保守治疗的采用，而诊断时年龄和诊断后生活方式会影响保守治疗后根治性治疗的启动率。这些结果可为低危/有利中危前列腺癌的临床管理提供参考。
查看英文原文 English abstract
Background Low-risk and favourable-intermediate risk prostate cancer patients are eligible for conservative management. We estimated the probability of conservative management uptake and 10-year rates of curative treatment initiation following conservative management in a prospective cohort of 2,872 health professionals diagnosed with low or favorable-intermediate risk prostate cancer. Methods The study included males with low-risk (grade group 1, stage≤cT2a, prostate-specific antigen (PSA)<10ng/ml) and favourable-intermediate risk (grade group 1, stage cT2b-cT2c or PSA 10-20ng/ml, or grade group 2, stage≤cT2a and PSA<10ng/ml) prostate cancer whom were diagnosed 1986-2019 and were participants in the Health Professionals Follow-up Study. We estimated the variation in conservative management uptake by age and calendar year at diagnosis, prostate cancer risk group, and pre-diagnostic lifestyle using Poisson regression. We estimated 10-year rates of curative treatment initiation in patients that initially received conservative management using Fine and Gray models adjusted for competing risks of lethal progression (prostate cancer death, metastasis, or initiation of hormone therapy) and other-cause death, censoring at December 2022. We assessed the variation in continuation to curative treatment with Cox models. Results The uptake of conservative management was 16% (444/2872). Conservative management was higher in older patients (1 year of additional age - Relative Risk (RR): 1.08, 95% CI: 1.06 - 1.11), in later calendar years (1 additional year - RR: 1.07, 95% CI 1.05 - 1.10)), and in neighborhoods of higher socioeconomic status (1 standard deviation rise - RR: 1.16. 95% CI 1.03 - 1.30). Uptake was lower in favorable-intermediate risk, rather than low-risk, prostate cancer (RR: 0.47. 95% CI 0.35 - 0.61). Among the 444 patients who initially received conservative management, when adjusted for competing risks of lethal progression and other-cause death, the 10-year curative treatment incidence was 22%. Patients were more likely to continue to curative treatment if they were younger at diagnosis (1 year of additional age - Hazard Ratio (HR): 0.96, 95% CI: 0.93 - 0.99) or had healthier post-diagnostic lifestyles (increase of 1 in joint measure of physical activity, BMI, and smoking, scored 0-3 - HR: 1.47, 95% CI 1.01 - 2.15). Conclusion We found age at diagnosis, calendar year at diagnosis, prostate cancer risk group, and neighborhood-level socioeconomic status to affect conservative management uptake, and age at diagnosis and post-diagnostic lifestyle to affect rates of curative treatment initiation following conservative management, in low/favorable-intermediate risk prostate cancer patients. These results could inform the clinical management of low/favorable-intermediate risk prostate cancer.
利益披露 Disclosure
I. Allen, None.. J. E. Hart, None.. M. A. Preston, None.. A. Pettersson, None.. K. Salari, None.. A. S. Kibel, None. L. A. Mucci, Convergent Therapuetics Other, Equity. Unrelated to submitted work.. T. Rebbeck, None.

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