Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
Cancer. 2011 Nov 1;117(21):4855-60. doi: 10.1002/cncr.26132. Epub 2011 Apr 11.
The objective of this study was to evaluate changes in clinical and pathologic characteristics of prostate cancer in patients who underwent surgery at a large tertiary care center in the context of increased use of active surveillance (AS) and minimally invasive surgery (MIS).
The authors retrospectively reviewed 6624 patients with localized prostate cancer who underwent radical prostatectomy from 2000 to 2010 at Memorial Sloan-Kettering Cancer Center. Patients were stratified by surgical approach (open, laparoscopic, or robotic) and by risk category (low, intermediate, or high). Patients with low-risk disease, without intervention, and with a minimum follow-up of 6 months were considered to have elected AS.
The number of patients who had AS increased from <20 per year between 2000 and 2004 to ≥ 100 per year between 2007 and 2009. Over the same decade, the number of patients who underwent MIS (laparoscopic or robotic) increased from zero to 63% of all surgical cases. The percentage of patients in the intermediate-risk and high-risk categories increased over time, whereas the percentage of patients in the low-risk category decreased (odds ratio [OR] per year, 0.91; 95% confidence interval [CI], 0.89-0.92; P < .0005). The proportion of patients who underwent surgery with Gleason 6 tumors decreased over time (OR per year, 0.87; 95% CI, 0.85-0.88; P < .0005), whereas pathologic stage and Gleason score increased (P < .0005). The proportion of low-risk patients decreased across all types of surgery, and the largest decrease was observed for robotic surgery (P < .0005).
A reverse stage shift was observed in patients who underwent radical prostatectomy after 2000 despite the introduction and rapid proliferation of MIS. This shift may have been caused in part by the increased use of AS and an institutional focus on the treatment of higher risk disease.
本研究旨在评估在大型三级保健中心，随着主动监测（AS）和微创外科（MIS）的广泛应用，接受手术治疗的患者的前列腺癌临床和病理特征的变化。
作者回顾性分析了 2000 年至 2010 年在纪念斯隆-凯特琳癌症中心接受根治性前列腺切除术的 6624 例局限性前列腺癌患者。患者按手术方式（开放、腹腔镜或机器人）和风险类别（低、中、高）分层。对于低危疾病患者，如果不干预且随访时间至少 6 个月，则认为其选择了 AS。
接受 AS 的患者人数从 2000 年至 2004 年每年不到 20 人增加到 2007 年至 2009 年每年 100 人以上。在同一十年间，接受 MIS（腹腔镜或机器人）手术的患者人数从零增加到所有手术病例的 63%。中危和高危患者的比例随时间增加，而低危患者的比例减少（每年的比值比，0.91；95%置信区间，0.89-0.92；P <.0005）。随着时间的推移，接受 Gleason 6 肿瘤手术的患者比例减少（每年的比值比，0.87；95%置信区间，0.85-0.88；P <.0005），而病理分期和 Gleason 评分增加（P <.0005）。所有类型手术的低危患者比例均下降，其中机器人手术降幅最大（P <.0005）。
尽管引入和快速普及了 MIS，但在 2000 年后接受根治性前列腺切除术的患者中观察到了逆向分期转移。这种转移可能部分是由于 AS 的广泛应用和机构对治疗高危疾病的关注所致。
