局限性前列腺癌治疗的循证分析

I. Abdalla, A. Basu, S. Hellman
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引用次数: 16

摘要

目的:局限性前列腺癌患者及其医生在决定治疗方案时面临着复杂的权衡。在这项研究中,我们修改了“需要治疗的数量”的方法来比较根治性前列腺切除术和放疗。方法采用MEDLINE方法检索所有根治性前列腺切除术或放疗治疗前列腺癌的研究。我们修改了治疗方案所需的数量,不仅考虑了存活,而且考虑了并发症及其效用。结果对总生存期的治疗价值需要的未调整的数字是6名患者支持前列腺切除术(6名患者接受前列腺切除术,比接受放疗的患者多1名10年生存率)。放疗患者比前列腺切除术患者年龄大4岁。由于总生存率与患者的年龄和整体健康状况密切相关,因此分析了治疗疾病特异性和远端无转移生存率所需的数量,以尽量减少患者选择偏差。疾病特异性和远端无转移生存所需的未调整数量分别为14和18。当需要治疗的人数根据并发症和效用进行调整时,其总生存率为14,疾病特异性生存率为-25,无远处转移生存率为-22,后两者倾向于放疗。结论前列腺切除术和放射治疗的效用调整数受并发症的可能性及其造成的效用损失的影响较大。当使用文献报道的值时,放疗是优越的,但结果的差异很小。随着前列腺特异性抗原的筛选和治疗方法的改进,这些值将发生变化,治疗所需的修改数可用于评估、报告和比较结果。在生存和生活质量方面的治疗结果决定了患者的选择和医生的建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
An Evidence‐Based Analysis of the Management of Localized Prostate Cancer
PURPOSEPatients with localized prostate cancer and their doctors face complex trade-offs when deciding on treatment. In this study, we modify the “number needed to treat” method to compare radical prostatectomy with radiotherapy. METHODSA MEDLINE search was performed to identify all studies of radical protatectomy or radiotherapy for prostate cancer. Number needed to treat formulas were modified to account for not only survival but also for complications and their utilities. RESULTSThe unadjusted number needed to treat value for overall survival was 6 favoring prostatectomy (six patients have to undergo prostatectomy to have one more 10-year survivor than if they had undergone radiotherapy). Radiotherapy patients were 4 years older than prostatectomy patients. Because overall survival is strongly linked to patients' age and overall health, the numbers needed to treat for disease-specific and distant metastasis-free survival were analyzed to minimize patient selection bias. The unadjusted number needed to treat values for disease-specific and distant metastasis-free survival were 14 and 18, respectively. When number needed to treat is adjusted for complications and utilities, its value for overall survival is 14, disease-specific survival is -25, and distant metastasis free survival is -22, these last two favoring radiotherapy. CONCLUSIONSUtility-adjusted numbers needed to treat for prostatectomy and radiotherapy are greatly influenced by the likelihood of complications and the utility loss ascribed to them. When literature-reported values are used, radiotherapy is superior, but the differences in outcomes are small. With prostate-specific antigen screening and refined treatment methods, these values will change, and the modified number needed to treat can be used to evaluate, report and compare results. The consequences of treatment in terms of both survival and quality of life determine patient choice and physician recommendations.
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