患者对临床局部性前列腺癌侵袭性治疗的预期寿命切线的偏好
John R Heard1, John M Masterson1, Michael Luu2
1Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.
Urologic oncology
|December 14, 2024
概括
患有前列腺癌的男性更喜欢保守的治疗,因为预期寿命下降. 这符合指导方针,除了低风险病例,男性选择更少的干预,即使寿命更长.
科学领域:
- 在瘤学瘤学.
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 医疗保健服务研究 医疗服务研究
背景情况:
- 目前针对寿命有限的男性的前列腺癌治疗指南依赖于专家意见.
- 基于长寿而推迟治疗的患者偏好尚未得到充分理解.
- 这项研究旨在确定影响前列腺癌主动治疗和保守治疗之间的选择的预期寿命值.
研究的目的:
- 为了确定预期寿命的门,男性更喜欢前列腺癌的保守管理.
- 评估不同癌症死亡风险和治疗副作用如何影响这一决定.
- 将患者的偏好与现有的临床指南进行比较.
主要方法:
- 进行了一项联合分析,对2,046名社会人口统计学上与美国前列腺癌人口相匹配的男性进行了分析.
- 参与者在各种寿命估计,癌症死亡风险和治疗副作用 (勃起功能障碍,尿失禁) 的场景下,在治疗和保守管理之间做出选择.
- 多变量逻辑回归分析了预期寿命和治疗偏好之间的关系.
主要成果:
- 长寿和治疗选择之间发现了显著的相互作用 (P < 0.001),随着预期寿命的缩短,治疗概率下降.
- 在所有癌症风险亚型中,男性更有可能选择保守的治疗,当预期寿命在所有癌症风险亚型中低于10年时.
- 保守管理的具体预期寿命值因癌症风险而异:≤15年 (低风险),≤10年 (有利中等),≤9年 (不利中等) 和≤7年 (高风险).
结论:
- 基于预期寿命的前列腺癌保守管理的患者偏好通常与当前指南建议保持一致.
- 对于低风险的前列腺癌,有一个例外,男性在指导方针所建议的寿命值高于预期寿命时更倾向于保守的治疗.
- 这些发现强调了将患者的寿命和偏好纳入前列腺癌治疗共享决策的重要性.
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