Department of Urology, Miller School of Medicine, University of Miami, Miami, FL 33101, USA.
BJU Int. 2013 Apr;111(4):574-9. doi: 10.1111/j.1464-410X.2012.11127.x. Epub 2012 May 4.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Active surveillance is an established management option for patients with favourable-risk prostate cancer. However, about 25-30% of active surveillance patients demonstrate biopsy progression within the first 3-5 years of follow-up. Although several factors, such as the results of the diagnostic and surveillance biopsies, are known to be associated with the risk of progression, our ability to accurately predict this risk remains limited. Our analysis demonstrated that the overall number of positive cores in the diagnostic and first surveillance biopsies is strongly associated with the risk of progression in active surveillance patients. Furthermore, combined results of diagnostic and first surveillance biopsies provide more information about the probability of progression than they do separately. The most important variable affecting the progression-free survival was the overall number of cores positive for cancer. By 3 years of active surveillance, most of the patients who had four positive cores in the diagnostic and surveillance biopsies progressed, while those who had only one positive core had an excellent prognosis. These findings could be used to improve the accuracy of assessments of the prognosis of patients with low-risk prostate cancer and to help them make informed decisions about their treatment.
To analyse the prognostic importance of information provided by the diagnostic biopsy, the first surveillance biopsy and a combination thereof to identify active surveillance patients with a particularly high risk of progression.
The present study included 161 active surveillance patients who had at least two surveillance biopsies. The first surveillance biopsy was performed within 1 year of the diagnosis. Further surveillance biopsies usually took place every 1-2 years. Progression on the surveillance biopsy was defined as the presence of Gleason 4/5 cancer, > two positive cores or >20% involvement of any core. Cox proportional hazards regression analysis was used to examine the relationship between biopsy characteristics and progression. Three distinct statistical models were built using characteristics of diagnostic biopsies, surveillance biopsies, and a combination thereof. Harrell's c-index was used to quantify the predictive accuracy of each multivariate Cox model.
The median follow-up was 3.6 years; 46 (28.6%) patients progressed. In multivariate analysis the major factor associated with progression was the number of positive cores. The model based on the combined results of diagnostic and first surveillance biopsies was significantly more predictive than the models based on the individual results of each biopsy. Patients with four positive cores in the diagnostic and first surveillance biopsies had estimated 5-year progression rate of 100%.
The total number of positive cores in the diagnostic and first surveillance biopsies provides important information about the risk of prostate cancer progression in active surveillance patients.
对于具有低危特征的前列腺癌患者，主动监测是一种已确立的管理选择。然而，约 25-30%的主动监测患者在最初 3-5 年的随访中表现出活检进展。尽管已知一些因素，如诊断和监测活检的结果，与进展风险相关，但我们准确预测这种风险的能力仍然有限。我们的分析表明，在主动监测患者中，诊断和首次监测活检中的阳性核心总数与进展风险密切相关。此外，诊断和首次监测活检的联合结果提供的关于进展概率的信息比单独提供的更多。影响无进展生存的最重要变量是诊断和监测活检中阳性核心的总数。在 3 年的主动监测中，大多数在诊断和监测活检中有 4 个阳性核心的患者进展，而只有 1 个阳性核心的患者则预后良好。这些发现可用于提高对低危前列腺癌患者预后评估的准确性，并帮助他们做出明智的治疗决策。
分析诊断性活检、首次监测性活检以及两者结合提供的信息的预后重要性，以确定进展风险特别高的主动监测患者。
本研究纳入了 161 名接受了至少两次监测性活检的主动监测患者。首次监测性活检在诊断后 1 年内进行。进一步的监测性活检通常每 1-2 年进行一次。在监测性活检中进展定义为存在 Gleason 4/5 级癌症、≥2 个阳性核心或任何核心的≥20%受累。使用 Cox 比例风险回归分析检查活检特征与进展之间的关系。使用诊断性活检、监测性活检和两者结合的特征构建了三个不同的统计模型。Harrell 的 c 指数用于量化每个多变量 Cox 模型的预测准确性。
中位随访时间为 3.6 年；46 名（28.6%）患者进展。多变量分析中与进展相关的主要因素是阳性核心数。基于诊断和首次监测活检联合结果的模型明显比基于每个活检单独结果的模型更具预测性。在诊断和首次监测活检中有 4 个阳性核心的患者，估计 5 年的进展率为 100%。
诊断和首次监测活检中的阳性核心总数为主动监测患者的前列腺癌进展风险提供了重要信息。
