Becker Andreas, Seiler Daniel, Kwiatkowski Maciej, Kluth Luis Alex, Schnell Dietrich, Graefen Markus, Schlomm Thorsten, Fisch Margit, Recker Franz, Weissbach Lothar, Chun Felix K H
Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany,
World J Urol. 2014 Aug;32(4):891-7. doi: 10.1007/s00345-014-1309-2. Epub 2014 May 13.
To date, evidence on active surveillance (AS) is restricted to protocol-based studies. Conversely, practice patterns outside of such protocols are unknown. The aim of this study was to capture the current AS treatment patterns for localized prostate cancer in patients managed by office-based urologists compared to patients treated at a tertiary care center.
Two prospective cohorts were investigated: 361 AS arm patients of the German Hormonal treatment, Active surveillance, Radiation therapy, OP, Watchful waiting (HAROW) study, an observational health service study and 387 protocol-based AS patients treated at the Department of Urology of the Kantonsspital Aarau, Switzerland were included. Observational non-protocol HAROW versus on-protocol Kantonsspital Aarau (KSA) was compared, and active-treatment-free survival represented the primary outcome.
Study population of the observational HAROW versus tertiary care protocol-based KSA cohorts differed statistically significantly regarding age (p < 0.001) and proportion of patients meeting the Chism criteria (p < 0.001). In stratified analyses, AFTS at 1 and 2 years was, respectively, 87.7 % (95 % CI 84.0-91.7) and 75.0 % (95 % CI 69.7-80.8) in HAROW patients compared to 90.8 % (95 % CI 87.8-93.9) and 75.3 % (95 % CI 70.7-80.1) for patients in the KSA cohort (p = 0.97).
We demonstrate significant differences in terms of AS inclusion, surveillance and discontinuation criteria between patients managed by office-based urologists compared to their tertiary care counterparts. Interestingly, the risk of deferred active therapy was equally moderate for both groups in the short-term follow-up.
迄今为止，关于主动监测（AS）的证据仅限于基于方案的研究。相反，此类方案之外的实践模式尚不清楚。本研究的目的是了解与在三级医疗中心接受治疗的患者相比，由门诊泌尿科医生管理的局限性前列腺癌患者当前的AS治疗模式。
调查了两个前瞻性队列：德国激素治疗、主动监测、放射治疗、手术、观察等待（HAROW）研究中的361例AS组患者，这是一项观察性卫生服务研究，以及在瑞士阿劳州立医院泌尿科接受治疗的387例基于方案的AS患者。比较了观察性非方案HAROW与基于方案的阿劳州立医院（KSA），无积极治疗生存期为主要结局。
观察性HAROW队列与基于三级医疗方案的KSA队列的研究人群在年龄（p<0.001）和符合Chism标准的患者比例（p<0.001）方面存在统计学显著差异。在分层分析中，HAROW患者1年和2年时的无积极治疗生存期分别为87.7%（95%CI 84.0-91.7）和75.0%（95%CI 69.7-80.8），而KSA队列患者分别为90.8%（95%CI 87.8-93.9）和75.3%（95%CI 70.7-80.1）（p=0.97）。
我们证明，与三级医疗同行相比,由门诊泌尿科医生管理的患者在AS纳入、监测和终止标准方面存在显著差异。有趣的是，在短期随访中，两组延迟积极治疗的风险同样适中。
