Department of Urology, University Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy.
BJU Int. 2010 Jun;105(11):1548-52. doi: 10.1111/j.1464-410X.2009.09057.x. Epub 2009 Nov 13.
To test the ability of two of the most stringent criteria used to identify patients with low-risk prostate cancer suitable for active surveillance (AS) to correctly exclude patients with unfavourable prostate cancer characteristics.
The study included 874 consecutive patients treated with radical prostatectomy (RP). We selected patients who could have been selected for AS according to the van den Bergh et al. and the Carter et al. criteria. We analysed the rates of advanced disease in these patients, defined as presence of either extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node invasion (LNI) and Gleason sum of 8-10 or 7-10.
Of 874 patients, 85 (9.7%) and 61 (6.9%) patients, respectively, qualified for AS according to the tested criteria. Within the van den Bergh et al. candidates, 5.9, 1.2, 1.2 and 1.2% of patients, respectively, showed ECE, SVI, LNI and high-grade Gleason sum 8-10 at pathology. Within the Carter et al. candidates, 3.3, 0, 3.3 and 0% of patients, respectively, showed ECE, SVI, LNI and high-grade Gleason sum 8-10. The cumulative rate of unfavourable characteristics was 7.1 and 3.3%. The rate increased to 28.2 and 27.9%, respectively, when Gleason sum 7 was considered as an unfavourable prostate cancer.
The use of the strictest criteria for AS inclusion identified 7-10% of the men in our cohort of men undergoing RP, as men that would have been eligible for AS. Among this small proportion, between 3.3 and 7.1% of patients harboured unfavourable prostate cancer characteristics. The clinical implications of these misclassification rates remain to be determined.
测试两种最严格的标准中用于识别适合主动监测（AS）的低危前列腺癌患者的能力，以正确排除具有不利前列腺癌特征的患者。
该研究纳入了 874 例接受根治性前列腺切除术（RP）的连续患者。我们选择了根据 van den Bergh 等人和 Carter 等人的标准可以选择进行 AS 的患者。我们分析了这些患者中晚期疾病的发生率，定义为存在包膜外扩展（ECE）、精囊侵犯（SVI）、淋巴结侵犯（LNI）和 Gleason 评分 8-10 或 7-10。
在 874 例患者中，分别有 85（9.7%）和 61（6.9%）例患者根据测试标准符合 AS 条件。在 van den Bergh 等人的候选者中，分别有 5.9%、1.2%、1.2%和 1.2%的患者在病理学上出现 ECE、SVI、LNI 和高级别 Gleason 评分 8-10。在 Carter 等人的候选者中，分别有 3.3%、0%、3.3%和 0%的患者出现 ECE、SVI、LNI 和高级别 Gleason 评分 8-10。不利特征的累积发生率为 7.1%和 3.3%。当将 Gleason 评分 7 视为不利前列腺癌时，发生率分别增加到 28.2%和 27.9%。
使用最严格的 AS 纳入标准确定了我们队列中接受 RP 的男性中有 7-10%的男性符合 AS 条件。在这一小部分人群中，3.3%至 7.1%的患者存在不利的前列腺癌特征。这些分类错误率的临床意义仍有待确定。
