Impact of adherence to criteria on oncological outcomes of radical prostatectomy in patients opting for active surveillance: data from the PRIAS-JAPAN study
Impact of adherence to criteria on oncological outcomes of radical prostatectomy in patients opting for active surveillance: data from the PRIAS-JAPAN study
复制标题
选择主动监测的患者遵守标准对根治性前列腺切除术肿瘤学结果的影响：来自 PRIAS-JAPAN 研究的数据
DOI：
10.1093/jjco/hyac092
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发表时间：
2022
影响因子：
2.4
通讯作者：
Matsumoto Ryuji
中科院分区：
文献类型：
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作者：
Tohi Yoichiro;Kato Takuma;Miyakawa Jimpei;Matsumoto Ryuji
目的本研究旨在评估在选择积极监测的患者中，根治性前列腺癌切除术的肿瘤学结果是否因坚持标准而有所不同。材料和方法我们回顾了参加PRIAS-JAPAN研究前瞻性队列的1035名患者的数据。应用排除标准后，对162例患者中的136例进行分析。重复活检病理重新分类导致的前列腺癌根治术的触发因素被定义为符合标准的。不符合标准的触发器被定义为不同于符合标准的触发器。对前列腺癌根治术不利的病理定义为病理性≥T3、≥GS 4+3和病理性N阳性。我们比较了两组前列腺癌根治术和前列腺特异性抗原无复发生存率的病理结果。结果前列腺癌根治术前前列腺特异性抗原的中位数在两组间有显著差异(6.1vs.8.3 ng/ml，P=0.007)。不符合标准的前列腺癌根治术的不良病理发生率(40.6%)低于不符合标准的患者(31.4%)，但差异无统计学意义(P=0.421)。两组患者术后前列腺特异性抗原无复发生存期(中位数：36个月)差异无统计学意义(Log-rankP=0.828)。结论半数不符合标准的患者在开始积极监测后的3年内接受了根治性前列腺切除术，其病理结果并不比符合标准的患者差。
ObjectivesThis study aimed to evaluate whether oncological outcomes of radical prostatectomy differ depending on adherence to the criteria in patients who opt for active surveillance.Materials and methodsWe retrospectively reviewed the data of 1035 patients enrolled in a prospective cohort of the PRIAS-JAPAN study. After applying the exclusion criteria, 136 of 162 patients were analyzed. Triggers for radical prostatectomy due to pathological reclassification on repeat biopsy were defined as on-criteria. Off-criteria triggers were defined as those other than on-criteria triggers. Unfavorable pathology on radical prostatectomy was defined as pathological ≥T3, ≥GS 4 + 3 and pathological N positivity. We compared the pathological findings on radical prostatectomy and prostate-specific antigen recurrence-free survival between the two groups. The off-criteria group included 35 patients (25.7%), half of whom received radical prostatectomy within 35 months.ResultsThere were significant differences in median prostate-specific antigen before radical prostatectomy between the on-criteria and off-criteria groups (6.1 vs. 8.3 ng/ml,P= 0.007). The percentage of unfavorable pathologies on radical prostatectomy was lower in the off-criteria group than that in the on-criteria group (40.6 vs. 31.4%); however, the differences were not statistically significant (P= 0.421). No significant difference in prostate-specific antigen recurrence-free survival was observed between the groups during the postoperative follow-up period (median: 36 months) (log-rankP= 0.828).ConclusionsHalf of the off-criteria patients underwent radical prostatectomy within 3 years of beginning active surveillance, and their pathological findings were not worse than those of the on-criteria patients.