Gleason Upgrading with Time in a Large Prostate Cancer Active Surveillance Cohort
Gleason Upgrading with Time in a Large Prostate Cancer Active Surveillance Cohort
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DOI：
10.1016/j.juro.2015.01.102
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发表时间：
2015-07-01
影响因子：
6.6
通讯作者：
Klotz, Laurence
中科院分区：
文献类型：
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作者：
Jain, Suneil;Loblaw, Andrew;Klotz, Laurence
目的：我们报告的百分比积极监测谁的疾病病理升级和因素，预测升级监测biopsies.Materials和方法：患者在我们的积极监测数据库中至少有1个重复前列腺活检。组织学升级定义为重复活检时原发性或继发性Gleason分级的任何增加。多变量分析用于确定与格里森升级相关的基线和动态因素。这些信息被用来开发一个诺模图预测升级或治疗的患者选择积极surveillance.Results：在我们的队列中的862例患者592有2个或更多的活检。中位随访时间为6.4年。20%的患者为中度风险，0.3%为高风险，其余均为低风险。在主动监测期间，31.3%的病例得到升级。在多变量分析中，临床分期T2，前列腺特异性抗原较高和诊断时涉及疾病的核心百分比较高预测升级。共有27例病例（升级病例的15%）在升级时为Gleason 8或更高，所有114例升级病例中有62%继续进行积极治疗。列线图包括临床分期、年龄、前列腺特异性抗原、核心阳性和Gleason评分。一致性指数为0.61。结论：在这个中期随访的大规模再活检队列中，大多数病例迄今为止没有病理升级。一个模型预测升级或根治性治疗的开发，这可能是有用的咨询患者考虑积极监测前列腺癌。
Purpose: We report the percentage of patients on active surveillance who had disease pathologically upgraded and factors that predict for upgrading on surveillance biopsies.Materials and Methods: Patients in our active surveillance database with at least 1 repeat prostate biopsy were included. Histological upgrading was defined as any increase in primary or secondary Gleason grade on repeat biopsy. Multivariate analysis was used to determine baseline and dynamic factors associated with Gleason upgrading. This information was used to develop a nomogram to predict for upgrading or treatment in patients electing for active surveillance.Results: Of 862 patients in our cohort 592 had 2 or more biopsies. Median followup was 6.4 years. Of the patients 20% were intermediate risk, 0.3% were high risk and all others were low risk. During active surveillance 31.3% of cases were upgraded. On multivariate analysis clinical stage T2, higher prostate specific antigen and higher percentage of cores involved with disease at the time of diagnosis predicted for upgrading. A total of 27 cases (15% of those upgraded) were Gleason 8 or higher at upgrading, and 62% of all 114 upgraded caseswent on to have active treatment. The nomogram incorporated clinical stage, age, prostate specific antigen, core positivity and Gleason score. The concordance index was 0.61.Conclusions: In this large re-biopsy cohort with medium-term followup, most cases have not been pathologically upgraded to date. A model predicting for upgrading or radical treatment was developed which could be useful in counseling patients considering active surveillance for prostate cancer.