Department of Urology, Vita-Salute University San Raffaele, Milan, Italy.
Cancer. 2012 Feb 15;118(4):973-80. doi: 10.1002/cncr.26234. Epub 2011 Jul 12.
The authors tested the performance of the currently used clinical criteria reported in populations studied by van den Bergh et al and Carter et al for the selection of patients with prostate cancer (PCa) for active surveillance (AS) according to age.
Data were analyzed from 893 patients who underwent with radical prostatectomy (RP). The authors investigated the rates of unfavorable PCa at RP (extracapsular extension, seminal vesicle or lymph node invasion, or Gleason score 7-10) in patients who fulfilled AS criteria according to age tertiles (ages ≤ 63 years, 63.1 to 69 years, and >69 years). Area under the curve (AUC) [corrected] analyses tested the criteria for predicting unfavorable PCa. Then, the patients were stratified according to the cutoff age of 70 years. Multivariate analyses were used to test the role of age in predicting unfavorable PCa.
The rate of unfavorable PCa characteristics was between 24% and 27.8%. In the van den Bergh et al population, after age 70 years, the rate of unfavorable PCa characteristics was 41% compared with 23.2% and 24.1% in patients in the previous age tertiles (ages ≤ 63 years and 63.1 to 69 years, respectively). In the Carter et al population, the rate of unfavorable PCa was 41.2% compared with 17.3% and 18.6% in the previous age tertiles (ages ≤ 63 years and 63.1 to 69 years, respectively). When the 70-year age cutoff was used, unfavorable PCa was identified in 17.9% to 23.6% of patients aged <70 years versus 4% to 41.2% of patients aged >70 years (all P < .001). AUC analyses revealed significantly lower performance in older patients. In multivariate analyses, after adjustment for prostate-specific antigen, prostate volume, and the number of cores, age represented an independent predictor of unfavorable PCa.
The currently used AS criteria performed significantly better for patients aged <70 years. The authors concluded that the current results should be taken into account when deciding whether to offer active surveillance to patients with low-risk PCa.
作者测试了 van den Bergh 等人和 Carter 等人在研究人群中报告的当前使用的临床标准在根据年龄选择前列腺癌 (PCa) 患者进行主动监测 (AS) 时的性能。
对 893 例接受根治性前列腺切除术 (RP) 的患者进行数据分析。作者调查了根据年龄三分位 (年龄≤63 岁、63.1 至 69 岁和>69 岁) 满足 AS 标准的患者在 RP 时发生不利 PCa 的发生率 (包膜外延伸、精囊或淋巴结侵犯或 Gleason 评分 7-10)。曲线下面积 (AUC) [校正] 分析测试了预测不利 PCa 的标准。然后，根据 70 岁的截止年龄对患者进行分层。使用多变量分析测试年龄在预测不利 PCa 中的作用。
不利 PCa 特征的发生率在 24%至 27.8%之间。在 van den Bergh 等人的人群中，年龄>70 岁时，不利 PCa 特征的发生率为 41%，而在前两个年龄三分位组（年龄≤63 岁和 63.1 至 69 岁）的发生率分别为 23.2%和 24.1%。在 Carter 等人的人群中，不利 PCa 的发生率为 41.2%，而在前两个年龄三分位组（年龄≤63 岁和 63.1 至 69 岁）的发生率分别为 17.3%和 18.6%。当使用 70 岁的截止年龄时，年龄<70 岁的患者中发现不利 PCa 的比例为 17.9%至 23.6%，而年龄>70 岁的患者中为 4%至 41.2%（均<0.001）。AUC 分析显示年龄较大的患者表现出明显较低的性能。在多变量分析中，在调整前列腺特异性抗原、前列腺体积和核心数量后，年龄是不利 PCa 的独立预测因素。
目前使用的 AS 标准在年龄<70 岁的患者中表现更好。作者得出结论，在决定是否为低危 PCa 患者提供主动监测时，应考虑当前结果。
