Incidence and Predictors of Upgrading and Up Staging among 10,000 Contemporary Patients with Low Risk Prostate Cancer
Incidence and Predictors of Upgrading and Up Staging among 10,000 Contemporary Patients with Low Risk Prostate Cancer
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DOI：
10.1016/j.juro.2015.02.015
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发表时间：
2015-08-01
影响因子：
6.6
通讯作者：
Nguyen, Paul L.
中科院分区：
文献类型：
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作者：
Dinh, Kathryn T.;Mahal, Brandon A.;Nguyen, Paul L.
目的：我们确定了当代临床低风险患者的病理升级和分期上升的发生率，并确定了隐匿性晚期疾病的预测因素，以便为主动监测患者的选择提供信息。材料与方法：我们研究了2010 - 2011年在SEER数据库中诊断为临床低危疾病（cT1c/T2a，前列腺特异性抗原小于10 ng/ml， Gleason 3+3=6）并行前列腺切除术的10273例患者。主要预后指标为升级为病理性Gleason评分7-10分或升级为病理性T3-T4/N1疾病的发生率。对具有完整活检数据的病例（5581例）进行多变量logistic回归，确定了升级或提高分期的重要预测因素，然后用于创建风险分层表。结果：在前列腺切除术中，44%的病例升级，9.7%的病例上升。对5,581例患者的多变量分析显示年龄、前列腺特异性抗原和阳性核数百分比(均p
Purpose: We determined the incidence of pathological upgrading and up staging for contemporary, clinically low risk patients, and identified predictors of having occult, advanced disease to inform the selection of patients for active surveillance.Materials and Methods: We studied 10,273 patients in the SEER database diagnosed with clinically low risk disease (cT1c/T2a, prostate specific antigen less than 10 ng/ml, Gleason 3+3=6) in 2010 to 2011 and treated with prostatectomy. The primary outcome was the incidence of upgrading to pathological Gleason score 7-10 or up staging to pathological T3-T4/N1 disease. Multivariable logistic regression of cases with complete biopsy data (5,581) identified significant predictors of upgrading or up staging, which were then used to create a risk stratification table.Results: At prostatectomy 44% of cases were upgraded and 9.7% were up staged. Multivariable analysis of 5,581 patients showed age, prostate specific antigen and percent positive cores (all p