Timilshina Narhari, Ouellet Veronique, Alibhai Shabbir M H, Mes-Masson Anne-Marie, Delvoye Nathalie, Drachenberg Darrel, Finelli Antonio, Jammal Marie-Paule, Karakiewicz Pierre, Lapointe Hélène, Lattouf Jean-Baptiste, Lynch Kenny, Paradis Jean-Benoît, Sitarik Paula, So Alan, Saad Fred
University Health Network, Toronto, ON, Canada.
Institut du Cancer de Montréal/Centre de recherche du CHUM, Montreal, QC, Canada.
World J Urol. 2017 Apr;35(4):595-603. doi: 10.1007/s00345-016-1897-0. Epub 2016 Jul 22.
Although the uptake of active surveillance (AS) appears to be increasing in published series, the uptake in most geographic regions remains largely unknown. Our aim was to examine practice patterns around the use of AS in low-risk prostate cancer in Canada. In addition, we examined regional variations in AS uptake, predictors of AS uptake, and persistent use for 12 months.
This is a retrospective multicentre review of low-risk patients who underwent a prostate biopsy in 2010 in six centres in four provinces (BC, QC, MB and ON). AS was identified based on chart review and required a minimum of 6 months of follow-up after diagnosis without any active treatment.
Of 986 patients, 781 patients (mean age 64 years) were incident cases and over three-quarters (77.3 %) chose AS at diagnosis. There were significant differences in uptake of AS by centre (range 65.0-98.0 %, p ≤ 0.05). Key multivariate predictors of pursuing AS included older age (OR 1.34, p = 0.044), centre (p = 0.021), lower number of cores (OR 1.09, p = 0.025), lower number of positive biopsy cores (OR 0.52, p < 0.001), and lower percent core involvement (OR 0.84, p < 0.001). In total, 516 (85.4 %) men remained on AS over 12 months. Maintenance with AS over 12 months differed by centre, ranging from 64.1 to 93.9 % (p = 0.001). Predictors of maintenance with AS over 12 months included older age, centre, and lower number of positive cores.
Active surveillance is widely practiced across Canada, but important regional differences were observed. Further analyses are required to understand the root causes of differences and to determine whether AS uptake is changing over time.
尽管在已发表的系列研究中，主动监测（AS）的采用率似乎在上升，但大多数地理区域的采用率仍很大程度上未知。我们的目的是研究加拿大低风险前列腺癌患者中AS的使用模式。此外，我们还研究了AS采用率的区域差异、AS采用的预测因素以及持续使用12个月的情况。
这是一项对2010年在四个省份（不列颠哥伦比亚省、魁北克省、曼尼托巴省和安大略省）的六个中心接受前列腺活检的低风险患者进行的回顾性多中心研究。通过病历审查确定AS，诊断后至少需要6个月的随访且无任何积极治疗。
在986例患者中，781例患者（平均年龄64岁）为初发病例，超过四分之三（77.3%）的患者在诊断时选择了AS。各中心AS的采用率存在显著差异（范围为65.0 - 98.0%，p≤0.05）。选择AS的关键多变量预测因素包括年龄较大（OR 1.34，p = 0.044）、中心（p = 0.021）、穿刺针数较少（OR 1.09，p = 0.025）、阳性活检穿刺针数较少（OR 0.52，p < 0.001）以及穿刺针受累百分比较低（OR 0.84，p < 0.001）。总共有516名（85.4%）男性在12个月内持续接受AS。12个月内AS的维持情况因中心而异，范围为64.1%至93.9%（p = 0.001）。12个月内AS维持的预测因素包括年龄较大、中心以及阳性穿刺针数较少。
主动监测在加拿大广泛应用，但观察到了重要的区域差异。需要进一步分析以了解差异的根本原因，并确定AS的采用率是否随时间变化。
