Long-Term Follow-Up of a Large Active Surveillance Cohort of Patients With Prostate Cancer
Long-Term Follow-Up of a Large Active Surveillance Cohort of Patients With Prostate Cancer
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DOI：
10.1200/jco.2014.55.1192
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发表时间：
2015-01-20
影响因子：
45.3
通讯作者：
Loblaw, Andrew
中科院分区：
文献类型：
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作者：
Klotz, Laurence;Vesprini, Danny;Loblaw, Andrew
主动监测作为高危前列腺癌的治疗选择越来越被接受。缺乏长期的后续行动。在这项研究中，我们报告了长期的结果，一个大的积极监测协议在男性与可预见的风险prostate cancer.Patients和MethodsIn前瞻性单臂队列研究进行了一个单一的学术健康科学中心，993名男性可预见的或中等风险的前列腺癌进行了管理与初步预期的方法。对前列腺特异性抗原（PSA）倍增时间小于3年、Gleason评分进展或明确的临床进展进行干预。主要结果的措施是整体和疾病特异性生存率，治疗率，PSA失败率在治疗patients.ResultsAmong的819名幸存者，随访时间中位数为6.4年（范围，0.2至19.8年）。993例患者中有149例（15%）死亡，844例患者存活（删失率，85.0%）。有15例（1.5%）死于前列腺癌。10年和15年的精算原因特异性生存率分别为98.1%和94.3%。另有13例患者（1.3%）发生转移性疾病，并因确认转移而存活（n = 9）或死于其他原因（n = 4）。在5年、10年和15年时，75.7%、63.5%和55.0%的患者仍未接受治疗并接受监测。非前列腺癌与前列腺癌死亡率的累积风险比为9.2：1。结论对高危前列腺癌进行积极监测是可行的，在15年的时间框架内似乎是安全的。在我们的队列中，2.8%的患者发生了转移性疾病，1.5%的患者死于前列腺癌。该死亡率与接受初始明确干预治疗的高危患者的预期死亡率一致。(C)2014年美国临床肿瘤学会
PurposeActive surveillance is increasingly accepted as a treatment option for favorable-risk prostate cancer. Long-term follow-up has been lacking. In this study, we report the long-term outcome of a large active surveillance protocol in men with favorable-risk prostate cancer.Patients and MethodsIn a prospective single-arm cohort study carried out at a single academic health sciences center, 993 men with favorable-or intermediate-risk prostate cancer were managed with an initial expectant approach. Intervention was offered for a prostate-specific antigen (PSA) doubling time of less than 3 years, Gleason score progression, or unequivocal clinical progression. Main outcome measures were overall and diseasespecific survival, rate of treatment, and PSA failure rate in the treated patients.ResultsAmong the 819 survivors, the median follow-up time from the first biopsy is 6.4 years (range, 0.2 to 19.8 years). One hundred forty-nine (15%) of 993 patients died, and 844 patients are alive (censored rate, 85.0%). There were 15 deaths (1.5%) from prostate cancer. The 10-and 15-year actuarial cause-specific survival rates were 98.1% and 94.3%, respectively. An additional 13 patients (1.3%) developed metastatic disease and are alive with confirmed metastases (n = 9) or have died of other causes (n = 4). At 5, 10, and 15 years, 75.7%, 63.5%, and 55.0% of patients remained untreated and on surveillance. The cumulative hazard ratio for nonprostate-to-prostate cancer mortality was 9.2: 1.ConclusionActive surveillance for favorable-risk prostate cancer is feasible and seems safe in the 15-year time frame. In our cohort, 2.8% of patients have developed metastatic disease, and 1.5% have died of prostate cancer. This mortality rate is consistent with expected mortality in favorable-risk patients managed with initial definitive intervention. (C) 2014 by American Society of Clinical Oncology