Five-year Outcomes of Magnetic Resonance Imaging-based Active Surveillance for Prostate Cancer: A Large Cohort Study
Five-year Outcomes of Magnetic Resonance Imaging-based Active Surveillance for Prostate Cancer: A Large Cohort Study
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DOI：
10.1016/j.eururo.2020.03.035
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发表时间：
2020-09-01
期刊：
影响因子：
23.4
通讯作者：
Moore, Caroline M.
中科院分区：
文献类型：
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作者：
Stavrinides, Vasilis;Giganti, Francesco;Moore, Caroline M.
背景资料：虽然多参数磁共振成像（mpMRI）在前列腺癌主动监测（AS）中的应用越来越受到关注，但现有数据来自于小的cohols.Objective：我们描述了一个已建立的AS项目的临床、组织学和放射学结果，其中省略了基于协议的活检，以支持MRI主导的监测。设计、设置和参与者：2004年8月至2017年11月期间入组AS的672名男性的数据（入选标准：Gleason 3 + 3或3 + 4局限性前列腺癌，呈现前列腺特异性抗原= 4 + 3。放射学和组织学进展的数据也covered.Results和局限性：超过3800人年（PY）的后续累计（中位数：58个月，四分位数间距37-82个月）。大约84.7%（95%置信区间[CI]：82.0-87.6）和71.8%（95% CI：68.2-75.6）的患者分别在3年和5年时保持AS。基线时MRI可见（Likert 4-5）疾病或继发性Gleason模式4的患者EFS和TFS较低（对数秩检验; p < 0.001）。共有216名男性接受治疗。有24例死亡，均与前列腺癌无关（6.3/1000 py; 95% CI：4.1-9.5）。8例患者发生转移（2.1例/1000 py; 95%CI：1.0-4.3），而27例患者在随访活检时升级为Gleason ≥ 4 + 3（7.7例/1000 py; 95%CI：5.2-11.3）。结论：MRI监测的停药率、死亡率和转移率与标准AS相当。基线时MRI可见疾病和/或继发性Gleason 4级与5年时转为积极治疗的可能性更大相关。进一步的研究将集中在优化成像间隔根据基线risk.Patient摘要：在这份报告中，我们研究了结果的磁共振成像（MRI）为基础的监测前列腺癌在英国的队列。我们发现，这种策略可以避免常规活检。次级Gleason模式4和MRI可见性与治疗率增加相关。我们的结论是，基于MRI的监测应考虑监测小前列腺肿瘤。(C)2020年，任作家。由Elsevier B. V.代表欧洲泌尿外科协会发布。
Background: Although the use of multiparametric magnetic resonance imaging (mpMRI) in active surveillance (AS) for prostate cancer is of increasing interest, existing data are derived from small cohorts.Objective: We describe clinical, histological, and radiological outcomes from an established AS programme, where protocol-based biopsies were omitted in favour of MRI-led monitoring.Design, setting, and participants: Data on 672 men enrolled in AS between August 2004 and November 2017 (inclusion criteria: Gleason 3 + 3 or 3 + 4 localised prostate cancer, presenting prostate-specific antigen = 4 + 3. Data on radiological and histological progression were also collected.Results and limitations: More than 3800 person-years (py) of follow-up were accrued (median: 58 mo; interquartile range 37-82 mo). Approximately 84.7% (95% confidence interval [CI]: 82.0-87.6) and 71.8% (95% CI: 68.2-75.6) of patients remained on AS at 3 and 5 yr, respectively. EFS and TFS were lower in those with MRI-visible (Likert 4-5) disease or secondary Gleason pattern 4 at baseline (log-rank test; p < 0.001). In total, 216 men were treated. There were 24 deaths, none of which was prostate cancer related (6.3/1000 py; 95% CI: 4.1-9.5). Metastases developed in eight men (2.1 events/1000 py; 95% CI: 1.0-4.3), whereas 27 men upgraded to Gleason >= 4 + 3 on follow-up biopsy (7.7 events/1000 py; 95% CI: 5.2-11.3).Conclusions: The rates of discontinuation, mortality, and metastasis in MRI-led surveillance are comparable with those of standard AS. MRI-visible disease and/or secondary Gleason grade 4 at baseline are associated with a greater likelihood of moving to active treatment at 5 yr. Further research will concentrate on optimising imaging intervals according to baseline risk.Patient summary: In this report, we looked at the outcomes of magnetic resonance imaging (MRI)-based surveillance for prostate cancer in a UK cohort. We found that this strategy could allow routine biopsies to be avoided. Secondary Gleason pattern 4 and MRI visibility are associated with increased rates of treatment. We conclude that MRI-based surveillance should be considered for the monitoring of small prostate tumours. (C) 2020 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology.