Population Based Study of Use and Determinants of Active Surveillance and Watchful Waiting for Low and Intermediate Risk Prostate Cancer
Population Based Study of Use and Determinants of Active Surveillance and Watchful Waiting for Low and Intermediate Risk Prostate Cancer
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DOI：
10.1016/j.juro.2013.05.054
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发表时间：
2013-11-01
影响因子：
6.6
通讯作者：
Stattin, Par
中科院分区：
文献类型：
--
作者：
Loeb, Stacy;Berglund, Anders;Stattin, Par
目的：先前的研究报道了美国低风险前列腺癌延迟治疗（即主动监测或观察等待）的使用不足。我们研究了瑞典全国前列腺癌登记中主动监测和观察等待的当代趋势。我们还研究了与选择递延管理相关的因素，这可能为这一重要管理策略的合理扩散提供见解。材料与方法：我们确定了57,713名极低风险（T1c， Gleason 6或以下，前列腺特异性抗原小于10 ng/ml，前列腺特异性抗原密度小于0.20 ng/ml/cc， 2个或更少阳性活检针或少于25%的针阳性），低风险（T1-T2， Gleason 6或更少，前列腺特异性抗原小于10 ng/ml）和中危前列腺癌(T1-T2，Gleason 7和/或前列腺特异性抗原10 ~ 20ng /ml)在PCBaSe（瑞典前列腺癌数据库）中的检测。从2007年开始，可以对极低风险疾病进行亚分类，并进行主动监测vs观察等待。我们检查了风险组的主要治疗选择，并使用逻辑回归来评估与延迟治疗相关的因素。结果：13272例（46%）低危前列腺癌患者和8695例（30%）中危前列腺癌患者选择了延期治疗。自2007年以来，极低、低、中危前列腺癌患者分别有59%、41%和16%选择了主动监测。到目前为止，年龄是延迟治疗的最重要决定因素。教育程度、婚姻状况和合并症与延迟治疗有显著但微弱的相关性。结论：瑞典经常使用延迟治疗低、中危前列腺癌。对于进展风险低的男性，将诊断与治疗分离可以降低过度治疗的发生率。
Purpose: Prior studies have reported the underuse of deferred treatment (ie active surveillance or watchful waiting) for low risk prostate cancer in the United States. We examined contemporary trends in active surveillance and watchful waiting in the nationwide Swedish prostate cancer registry. We also examined factors associated with selection of deferred management, which might provide insight into the rational diffusion of this important management strategy.Materials and Methods: We identified 57,713 men with very low risk (T1c, Gleason 6 or less, prostate specific antigen less than 10 ng/ml, prostate specific antigen density less than 0.20 ng/ml/cc, 2 or fewer positive biopsy cores or less than 25% of cores positive), low risk (T1-T2, Gleason 6 or less, and prostate specific antigen less than 10 ng/ml) and intermediate risk prostate cancer (T1-T2, Gleason 7 and/or prostate specific antigen 10 to 20 ng/ml) in the PCBaSe (Prostate Cancer database Sweden) from 1998 to 2011. Subclassification of very low risk disease, and active surveillance vs watchful waiting was possible beginning in 2007. We examined primary treatment selection by risk group and used logistic regression to evaluate factors associated with deferred treatment.Results: Overall 13,272 (46%) men with low risk and 8,695 (30%) with intermediate risk prostate cancer chose deferred treatment. Since 2007, 59%, 41% and 16% of very low, low and intermediate risk prostate cancer, respectively, chose active surveillance. Age was by far the strongest determinant of deferred treatment. Education, marital status and comorbidity were significantly but weakly associated with deferring treatment.Conclusions: Deferred treatment for low and intermediate risk prostate cancer was frequently used in Sweden. Dissociating diagnosis from treatment in men with a low risk of progression can decrease the rate of overtreatment.