Outcomes of Active Surveillance for Clinically Localized Prostate Cancer in the Prospective, Multi-Institutional Canary PASS Cohort
Outcomes of Active Surveillance for Clinically Localized Prostate Cancer in the Prospective, Multi-Institutional Canary PASS Cohort
复制标题
DOI：
10.1016/j.juro.2015.08.087
复制
发表时间：
2016-02-01
影响因子：
6.6
通讯作者：
Lin, Daniel W.
中科院分区：
文献类型：
--
作者：
Newcomb, Lisa F.;Thompson, Ian M., Jr.;Lin, Daniel W.
目的：积极监测是解决前列腺癌过度治疗的一种策略，但个体患者预后的不确定性仍是一个令人担忧的问题。我们对积极监测的前瞻性多中心研究的结果进行了评估。材料和方法：我们研究了905名在2008至2013年间登记的前瞻性金丝雀通行证患者。我们在研究开始时和预先指定的时间间隔收集临床数据，并确定与不利重新分类的相关性，不利重新分类的定义是随访活检时Gleason分级增加或更大的肿瘤体积。我们还评估了在经过一段时间的积极监测后接受手术的参与者的临床参数与病理结果的关系。结果：在中位数28个月的随访中，24%的参与者经历了不利的重新分类，其中53%接受了治疗，31%继续接受积极监测。总体而言，19%的参与者接受了治疗，68%的患者进行了不利的重新分类，而32%的参与者选择了不进行疾病重新分类的治疗。在多因素COX比例风险模型中，肿瘤活检中心百分比、体重指数和前列腺特异性抗原密度与不利的再分类相关(p分别为0.01、0.04、0.04)。在随后接受根治性前列腺切除术的103名参与者中，34%的患者有不良病理，定义为主要的4-5型或非器官受限疾病，包括2例淋巴结阳性，诊断时的风险类别与手术结果之间没有显著关系(p=0.76)。结论：大多数男性在5年后仍在积极监测，手术中没有不利的重新分类或不利的病理。然而，临床因素与疾病重新分类的相关性不大，这支持了改进这一结果预测的方法的必要性。
Purpose: Active surveillance represents a strategy to address the overtreatment of prostate cancer, yet uncertainty regarding individual patient outcomes remains a concern. We evaluated outcomes in a prospective multicenter study of active surveillance.Materials and Methods: We studied 905 men in the prospective Canary PASS enrolled between 2008 and 2013. We collected clinical data at study entry and at prespecified intervals, and determined associations with adverse reclassification, defined as increased Gleason grade or greater cancer volume on followup biopsy. We also evaluated the relationships of clinical parameters with pathology findings in participants who underwent surgery after a period of active surveillance.Results: At a median followup of 28 months 24% of participants experienced adverse reclassification, of whom 53% underwent treatment while 31% continued on active surveillance. Overall 19% of participants received treatment, 68% with adverse reclassification, while 32% opted for treatment without disease reclassification. In multivariate Cox proportional hazards modeling the percent of biopsy cores with cancer, body mass index and prostate specific antigen density were associated with adverse reclassification (p = 0.01, 0.04, 0.04, respectively). Of 103 participants subsequently treated with radical prostatectomy 34% had adverse pathology, defined as primary pattern 4-5 or nonorgan confined disease, including 2 with positive lymph nodes, with no significant relationship between risk category at diagnosis and findings at surgery (p = 0.76).Conclusions: Most men remain on active surveillance at 5 years without adverse reclassification or adverse pathology at surgery. However, clinical factors had only a modest association with disease reclassification, supporting the need for approaches that improve the prediction of this outcome.