Association of Negative Followup Biopsy and Reclassification during Active Surveillance of Prostate Cancer: A Systematic Review and Meta-Analysis.
Association of Negative Followup Biopsy and Reclassification during Active Surveillance of Prostate Cancer: A Systematic Review and Meta-Analysis.
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前列腺癌主动监测期间阴性随访活检与重新分类的关联：系统回顾和荟萃分析。
DOI：
10.1097/ju.0000000000001701
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Shariat,ShahrokhF
中科院分区：
文献类型：
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作者：
Rajwa,Pawel;Pradere,Benjamin;Mori,Keiichiro;Ploussard,Guillaume;Leapman,MichaelS;Shariat,ShahrokhF
目的随着主动监测的日益普及，越来越需要能够调整监测强度的临床参数。因此，我们的目的是评估阴性随访活检对于主动监测的前列腺癌患者重新分类和升级的预后价值。材料和方法根据系统审查和荟萃分析声明的首选报告项目，查询 PubMed®、Web of ScienceTM 和 Scopus® 数据库，以确定截至 2020 年 11 月发表的相关研究。我们对整个队列和选定亚组的重新分类和升级进行了正式的荟萃分析。结果我们分别确定了 13 项和 9 项符合系统评价和荟萃分析资格的研究。荟萃分析共纳入 2,628 名患者。任何阴性随访活检均与显着降低的重新分类风险（HR 0.46，95% CI 0.39–0.55；p <0.01）和升级风险（HR 0.54，95% CI 0.44–0.66；p <0.01）相关。对于验证性活检亚组，重新分类（HR 0.44，95% CI 0.36-0.55；p <0.01）和升级（HR 0.55，95% CI 0.42-0.73；p <0.01）的结果仍然显着。这些模式在仅具有格里森分级预后组 1 的患者中仍然稳健（重新分类 HR 0.47，95% CI 0.39–0.57；p <0.01；升级 HR 0.54，95% CI 0.42–0.69；p <0.01）。 结论 阴性随访活检与未来重新分类和升级风险降低约 50% 相关。将阴性后续活检纳入当前方案应可实现个性化的主动监测定制和更精确的决策。
PurposeWith the growing adoption of active surveillance clinical parameters that can tailor the intensity of monitoring are increasingly needed. Therefore, we aimed to evaluate the prognostic value of negative followup biopsy for reclassification and upgrading in prostate cancer patients managed with active surveillance.Materials and MethodsThe PubMed®, Web of ScienceTM, and Scopus® databases were queried to identify relevant studies published until November 2020 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. We performed a formal meta-analysis for the reclassification and upgrading in the full cohort and selected subgroups.ResultsWe identified 13 and 9 studies eligible for the systematic review and meta-analysis, respectively. A total of 2,628 patients were included in the meta-analysis. Any negative followup biopsy was associated with significantly lower risk of reclassification (HR 0.46, 95% CI 0.39–0.55; p <0.01), and upgrading (HR 0.54, 95% CI 0.44–0.66; p <0.01). For the confirmatory biopsy subgroup, the results remained significant for reclassification (HR 0.44, 95% CI 0.36–0.55; p <0.01) and upgrading (HR 0.55, 95% CI 0.42–0.73; p <0.01). These patterns remained robust among patients with only Gleason Grade prognostic group 1 (reclassification HR 0.47, 95% CI 0.39–0.57; p <0.01; upgrading HR 0.54, 95% CI 0.42–0.69; p <0.01).ConclusionsA negative followup biopsy is associated with an approximately 50% decrease in the risk of future reclassification and upgrading. Incorporation of the negative followup biopsy into current protocols should allow for personalized active surveillance tailoring and more precise decision making.