Schiffmann Jonas, Wenzel Philipp, Salomon Georg, Budäus Lars, Schlomm Thorsten, Minner Sarah, Wittmer Corinna, Kraft Stefan, Krech Till, Steurer Stefan, Sauter Guido, Beyer Burkhard, Boehm Katharina, Tilki Derya, Michl Uwe, Huland Hartwig, Graefen Markus, Karakiewicz Pierre I
Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Urol Oncol. 2015 Jul;33(7):329.e13-9. doi: 10.1016/j.urolonc.2015.04.004. Epub 2015 May 7.
To date, no study has examined clinical, pathological, and surgical characteristics of D׳Amico low-risk patients according to active surveillance (AS) eligibility.
We relied on patients with low-risk prostate cancer, who were classified based on the D׳Amico classification, treated with radical prostatectomy (RP) between 2008 and 2013 at the Martini-Clinic Prostate Cancer Center. We assessed differences in clinical, pathological, and surgical characteristics in D׳Amico low-risk patients according to AS eligibility (prostate-specific antigen [PSA]≤ 10 ng/ml, Gleason score ≤ 3 + 3, ≤ 2 positive cores,≤5 0% tumor content per core, and ≤ cT1-2a). Multivariable logistic regression analyses targeted 2 end points: (1) presence of either intermediate- or high-risk characteristics (Gleason score ≥ 3+4 or ≥ pT3 or pN1) or (2) exclusive presence of high-risk characteristics (Gleason score ≥ 4+4 or ≥ pT3 or pN1) at RP.
Of 1,331 patients low-risk prostate cancer classified based on the D׳Amico classification, 825 (62%) men were eligible for AS. AS candidates were less frequently either upgraded (55% vs. 78%, P<0.001) or upstaged (8% vs. 15%, P<0.001). Similarly, at final pathology, AS candidates less frequently harbored either intermediate- or high-risk (56% vs. 78%, P<0.001), or exclusive high-risk characteristics (9% vs. 16%, P<0.001). Tumor involvement per core (>50%) (most powerful), number of positive cores, PSA values, and age were independent predictors for either intermediate- or high-risk characteristics at RP. Tumor involvement per core and PSA values were independent predictors for exclusive high-risk characteristics at RP.
D׳Amico low-risk patients did not have a homogeneous histology at RP. Especially, non-AS candidates were at a higher risk of either upgrading or upstaging at final pathology. Tumor involvement greater than 50% per core was the most powerful indicator of adverse pathology. Therefore, D'Amico low-risk criteria are not safe enough to identify AS candidates.
迄今为止，尚无研究根据主动监测（AS）的适用性来研究D'Amico低风险患者的临床、病理和手术特征。
我们纳入了2008年至2013年间在马提尼诊所前列腺癌中心接受根治性前列腺切除术（RP）治疗的低风险前列腺癌患者，这些患者根据D'Amico分类进行分类。我们评估了根据AS适用性（前列腺特异性抗原[PSA]≤10 ng/ml、Gleason评分≤3 + 3、阳性核心≤2个、每个核心肿瘤含量≤50%以及≤cT1 - 2a）的D'Amico低风险患者在临床、病理和手术特征方面的差异。多变量逻辑回归分析针对2个终点：（1）在RP时存在中风险或高风险特征（Gleason评分≥3 + 4或≥pT3或pN1）或（2）在RP时仅存在高风险特征（Gleason评分≥4 + 4或≥pT3或pN1）。
在根据D'Amico分类的1331例低风险前列腺癌患者中，825例（62%）男性符合AS标准。符合AS标准的患者升级（55%对78%，P<0.001）或分期上升（8%对15%，P<0.001）的频率较低。同样，在最终病理检查中，符合AS标准的患者具有中风险或高风险（56%对78%，P<0.001）或仅具有高风险特征（9%对16%，P<0.001）的频率较低。每个核心的肿瘤累及情况（>50%）（最具影响力）、阳性核心数量、PSA值和年龄是RP时中风险或高风险特征的独立预测因素。每个核心的肿瘤累及情况和PSA值是RP时仅具有高风险特征的独立预测因素。
D'Amico低风险患者在RP时组织学并不一致。特别是，不符合AS标准的患者在最终病理检查时升级或分期上升的风险更高。每个核心肿瘤累及大于50%是不良病理的最有力指标。因此，D'Amico低风险标准不足以安全地识别符合AS标准的患者。
