Department of Urology, The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
J Urol. 2013 Oct;190(4):1218-22. doi: 10.1016/j.juro.2013.04.071. Epub 2013 Apr 30.
We assessed oncologic outcomes at surgery in men with low risk and very low risk prostate cancer who were candidates for active surveillance.
In a prospectively collected institutional database, we identified 7,486 subjects eligible for active surveillance who underwent radical retropubic prostatectomy. Candidates were designated as being at low risk (stage T1c/T2a, prostate specific antigen 10 ng/ml or less, and Gleason score 6 or less) or very low risk (stage T1c, prostate specific antigen density 0.15 or less, Gleason score 6 or less, 2 or fewer positive biopsy cores, 50% or less cancer involvement per core) based on preoperative data. Adverse findings were Gleason score upgrade (score 7 or greater) and nonorgan confined cancer on surgical pathology. The relative risk of adverse findings in men at low risk with very low risk disease was evaluated in a multivariate model using Poisson regression.
A total of 7,333 subjects met the criteria for low risk disease and 153 had very low risk disease. The proportion of subjects at low risk found to have Gleason score upgrade or nonorgan confined cancer on final pathology was 21.8% and 23.1%, respectively. Corresponding values in those at very low risk were 13.1% and 8.5%, respectively. After adjusting for age, race, year of surgery, body mass index, and prostate specific antigen at diagnosis, the relative risk of Gleason score upgrade in men with low risk vs very low risk disease was 1.89 (95% CI 1.21-2.95). The relative risk of nonorgan confined cancer was 2.06 (95% CI 1.19-3.57).
Men with very low risk prostate cancer were at significantly lower risk for adverse findings at surgery compared to those with low risk disease. These data support the stratification of low risk cancer when selecting and counseling men who may be appropriate for active surveillance.
我们评估了适合主动监测的低危和极低危前列腺癌男性患者手术时的肿瘤学结局。
在一个前瞻性收集的机构数据库中，我们确定了 7486 名符合主动监测条件并接受根治性耻骨后前列腺切除术的患者。候选者被指定为低危（T1c/T2a 期，前列腺特异性抗原 10ng/ml 或更低，Gleason 评分 6 或更低）或极低危（T1c 期，前列腺特异性抗原密度 0.15 或更低，Gleason 评分 6 或更低，2 个或更少的阳性活检核心，每个核心的癌症累及 50%或更少），依据是术前数据。不良发现为 Gleason 评分升级（评分 7 或更高）和手术病理上的非器官局限癌。使用泊松回归的多变量模型评估低危疾病伴极低危疾病男性不良发现的相对风险。
共有 7333 名患者符合低危疾病标准，153 名患者有极低危疾病。最终病理上低危疾病患者中发现 Gleason 评分升级或非器官局限癌的比例分别为 21.8%和 23.1%，而极低危疾病患者中的比例分别为 13.1%和 8.5%。在调整年龄、种族、手术年份、体重指数和诊断时的前列腺特异性抗原后，低危疾病患者与极低危疾病患者的 Gleason 评分升级的相对风险为 1.89（95%CI 1.21-2.95）。非器官局限癌的相对风险为 2.06（95%CI 1.19-3.57）。
与低危疾病患者相比，极低危前列腺癌患者手术时发生不良发现的风险显著降低。这些数据支持在选择和咨询可能适合主动监测的男性时对低危癌症进行分层。
