Objective

To examine the utilization of adjuvant radiotherapy (aRT) in contemporary prostate cancer patients with adverse pathological features at radical prostatectomy (RP).

Methods

We identified 189,240 patients with adverse features at RP (positive margin, stage ≥pT3a, and/or pN1 disease), from 2004 to 2015, within the National Cancer Database, and validated our findings within Surveillance, Epidemiology, and End Results (SEER) program. We examined the utilization of patients with aRT with adverse features at RP and patients with very aggressive disease (at least 2 of the following: ≥pT3b, pathological Gleason 8-10, and pN1). Regression analysis examined the relationship of various predictors of utilization adjusting to confounders. Pseudo R² analysis examined the magnitude of influence that each variable had on the decision to use aRT.

Results

Within the National Cancer Database cohort, only 11.7% of our patients received aRT. In patients with very aggressive disease, aRT utilization rate was 28.9%. Within the SEER cohort, 16.3% of patients with any adverse features at time of RP received aRT. In patients with very aggressive disease, only 30% of patients received aRT. Further, year of diagnosis, Gleason grade, pathologic stage, and positive surgical margin were the variables that had the greatest influence on the decision to use aRT, and that positive surgical margin, type of institution at which care was received, and lymph node involvement were the most influential variables in patients with very aggressive disease.

Conclusions

The current standard of care in the United States represents a significant underutilization of aRT in eligible patients with prostate cancer. Urgent efforts are necessary to address this quality-of-care concern.

中文翻译：

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北美前列腺癌患者辅助放疗在全国范围内的持续利用不足。

目标

旨在检查在根治性前列腺切除术 (RP) 中具有不良病理特征的当代前列腺癌患者中辅助放疗 (aRT) 的使用情况。

方法

从 2004 年到 2015 年，我们在国家癌症数据库中确定了 189,240 名具有 RP 不良特征的患者（切缘阳性、分期≥pT3a 和/或 pN1 疾病），并在监测、流行病学和最终结果 (SEER) 中验证了我们的发现程序。我们检查了具有 RP 不良特征的 aRT 患者和具有非常侵袭性疾病的患者（以下至少 2 项：≥pT3b、病理性 Gleason 8-10 和 pN1）的利用率。回归分析检查了各种利用调整因素与混杂因素之间的关系。伪R ²分析检查了每个变量对使用 aRT 的决定的影响程度。

结果

在国家癌症数据库队列中，只有 11.7% 的患者接受了 aRT。在病情非常严重的患者中，aRT 使用率为 28.9%。在 SEER 队列中，16.3% 在 RP 时有任何不良特征的患者接受了 aRT。在病情非常严重的患者中，只有 30% 的患者接受了 aRT。此外，诊断年份、Gleason 分级、病理分期和阳性手术切缘是对使用 aRT 的决定影响最大的变量，阳性手术切缘、接受治疗的机构类型和淋巴结受累是侵袭性疾病患者最有影响的变量。

结论

美国目前的护理标准表明，在符合条件的前列腺癌患者中，aRT 的利用率明显不足。迫切需要努力解决这一护理质量问题。