Estimating the risks and benefits of active surveillance protocols for prostate cancer: a microsimulation study.
Estimating the risks and benefits of active surveillance protocols for prostate cancer: a microsimulation study.
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DOI：
10.1111/bju.13542
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发表时间：
2017-04
影响因子：
4.5
通讯作者：
de Koning HJ
中科院分区：
文献类型：
--
作者：
de Carvalho TM;Heijnsdijk EA;de Koning HJ
评估与立即治疗男性相比，不同主动监测（AS）方案导致的前列腺癌死亡率（PCM）增加和过度治疗减少。我们使用的微观模拟模型（MISCAN-Prostate），与自然历史的基础上ERSPC数据。我们根据约翰霍普金斯AS队列的数据，估计AS患者根据疾病分期接受根治性治疗的概率。我们对代表美国人口的1000万名男性进行了抽样，并与立即治疗男性相比，我们预测了在活检之间应用AS协议的效果。低风险患者（≤ T2 a分期和Gleason 6）每年随访活检的AS将PCM的概率增加至2.6%（增加1%），并将过度治疗从2.5%降至2.1%（减少18.4%）。第一年后每三年进行一次活检，PCM增加2.3%，过度治疗从2.5%减少到1.9%（减少30.3%）。纳入AS的中危男性（> T2 a分期或Gleason 3+4）可使PCM增加2.7%，并将过度治疗从2.5%降至2.0%（减少23.1%）。这些结果可能不适用于非洲裔美国人。为低风险患者提供AS相对安全。在第一年后，将活检间隔从每年增加到每3年，将显著减少低风险男性的过度治疗，PCM风险有限。
To estimate the increase in prostate cancer mortality (PCM) and the reduction in overtreatment resulting from different Active Surveillance (AS) protocols, compared to treating men immediately. We use a microsimulation model (MISCAN-Prostate), with natural history based on ERSPC data. We estimate probabilities of referral to radical treatment while on AS, depending on disease stage, with data from John Hopkins AS cohort. We sample 10 million men representative of the US population and we project the effects of applying AS protocols differing by time between biopsies, compared to treating men immediately. AS with yearly follow-up biopsies for low-risk patients (≤ T2a-stage and Gleason 6) increases the probability of PCM to 2.6% (1% increase) and reduces overtreatment from 2.5% to 2.1% (18.4% reduction). With biopsies every three years after the first year, PCM increases by 2.3% and overtreatment reduces from 2.5% to 1.9% (30.3% reduction). Including intermediate-risk men (> T2a-stage or Gleason 3+4) in AS increases PCM by 2.7% and reduces overtreatment from 2.5% to 2.0% (23.1% reduction). These results may not apply to African-American men. Offering AS for low-risk patients is relatively safe. Increasing the biopsy interval from yearly to up to every 3 years after the first year, will significantly reduce overtreatment among low-risk men, with limited PCM risk.
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DOI：
10.1200/jco.2015.62.5764
发表时间：
2015-10-20
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
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作者：
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DOI：
10.1056/nejmoa1311593
发表时间：
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期刊：
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影响因子：
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Johansson JE
影响因子：
120.7
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DOI：
10.1056/nejmoa1201637
发表时间：
2012-08-16
期刊：
The New England journal of medicine
影响因子：
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作者：
Heijnsdijk EA;Wever EM;Auvinen A;Hugosson J;Ciatto S;Nelen V;Kwiatkowski M;Villers A;Páez A;Moss SM;Zappa M;Tammela TL;Mäkinen T;Carlsson S;Korfage IJ;Essink-Bot ML;Otto SJ;Draisma G;Bangma CH;Roobol MJ;Schröder FH;de Koning HJ
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45.3
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