Komisarenko Maria, Wong Lih-Ming, Richard Patrick O, Timilshina Narhari, Toi Ants, Evans Andrew, Zlotta Alexandre, Kulkarni Girish, Hamilton Robert, Fleshner Neil, Finelli Antonio
Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network; Department of Pathology, Toronto General Hospital, University of Toronto (AE), Toronto, Ontario, Canada; Department of Urology, St. Vincent's Hospital, Melbourne, Australia (L-MW).
Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network; Department of Pathology, Toronto General Hospital, University of Toronto (AE), Toronto, Ontario, Canada; Department of Urology, St. Vincent's Hospital, Melbourne, Australia (L-MW).
J Urol. 2016 Feb;195(2):307-12. doi: 10.1016/j.juro.2015.09.081. Epub 2015 Sep 28.
We evaluated the relative risk of later grade reclassification and outcomes of patients in whom high volume Gleason 6 prostate cancer develops while on active surveillance.
A prospectively maintained database was used to identify patients on active surveillance between 1998 and 2013. Tumor volume was assessed based on the number of positive cores and proportion of core involvement. The chi-square and Fisher exact tests were used for analysis as appropriate. The primary end point was the development of grade reclassification, defined as grade only and/or grade and volume at the event biopsy.
A total of 555 men met the study inclusion criteria. Mean followup was 46 months. Overall 70 patients demonstrated an increase in tumor volume at or after biopsy 2. Compared to those men never experiencing volume or grade reclassification, prostate specific antigen at diagnosis was not significantly different (p=0.95), but median prostate volume was smaller in patients who demonstrated volume reclassification (p <0.001). The incidence of pure volume reclassification was 6.8%, 6.1% and 7.8% at biopsy 2, 3 and 4, respectively. Men with volume reclassification were more likely to experience later grade reclassification than those without at 33.3% vs 9.3%, respectively (p <0.0001).
While Gleason 6 prostate cancer has a favorable natural history, it appears that patients on active surveillance who experience volume reclassification are at substantially higher risk for grade reclassification. Thus, urologists should pay close attention to tumor core involvement, and monitoring should be adjusted accordingly for early volume reclassification in younger men and those in good health.
我们评估了在积极监测期间发生高体积Gleason 6前列腺癌的患者出现更高分级重新分类的相对风险及预后。
使用一个前瞻性维护的数据库来识别1998年至2013年间接受积极监测的患者。根据阳性核心的数量和核心受累比例评估肿瘤体积。酌情使用卡方检验和Fisher精确检验进行分析。主要终点是分级重新分类的发生，定义为事件活检时的分级仅和/或分级及体积。
共有555名男性符合研究纳入标准。平均随访时间为46个月。总体而言，70名患者在活检2时或之后肿瘤体积增加。与那些从未经历体积或分级重新分类的男性相比，诊断时的前列腺特异性抗原无显著差异（p = 0.95），但出现体积重新分类的患者中位前列腺体积较小（p <0.001）。在活检2、3和4时，单纯体积重新分类的发生率分别为6.8%、6.1%和7.8%。出现体积重新分类的男性比未出现的男性更有可能在之后出现分级重新分类，分别为33.3%和9.3%（p <0.0001）。
虽然Gleason 6前列腺癌具有良好的自然病程，但在积极监测中出现体积重新分类的患者似乎分级重新分类的风险要高得多。因此，泌尿外科医生应密切关注肿瘤核心受累情况，对于年轻且健康状况良好的男性，应根据早期体积重新分类相应调整监测。
