Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
J Urol. 2017 Sep;198(3):591-599. doi: 10.1016/j.juro.2017.03.123. Epub 2017 Mar 24.
We compare intermediate term clinical outcomes among men with favorable risk and intermediate/high risk prostate cancer managed by active surveillance.
A total of 635 men with localized prostate cancer have been on active surveillance since 2002 at a high volume academic hospital in the United States. Median followup is 50.5 months (IQR 31.1-80.3). Time to event analysis was performed for our clinical end points.
Of the cohort 117 men (18.4%) had intermediate/high risk disease. Overall 5 and 10-year all cause survival was 98% and 94%, respectively. Cumulative metastasis-free survival at 5 and 10 years was 99% and 98%, respectively. To date no cancer specific deaths had been observed. Overall freedom from intervention was 61% and 49% at 5 and 10 years, respectively. Overall cumulative freedom from failure of active surveillance, defined as metastasis or biochemical failure after local therapy with curative intent, was 97% and 91% at 5 and 10 years, respectively. Of the men 21 (9.9%) experienced biochemical failure after deferred treatment and the 5-year progression-free probability was 92%. Compared to men with favorable risk disease those with intermediate/high risk cancer experienced no difference in metastases, surveillance failure or curative intervention. However, patients at higher risk were at significantly increased risk for all cause mortality, likely reflecting patient selection factors. These conclusions may be limited by the small number of events and the duration of our study.
Patients with localized prostate cancer who are on active surveillance demonstrated a low rate of active surveillance failure, prostate cancer specific mortality and metastases regardless of baseline risk.
我们比较了通过主动监测管理的低危和中高危前列腺癌男性患者的中期临床结局。
自 2002 年以来，在美国一家高容量学术医院，共有 635 名局限性前列腺癌患者接受主动监测。中位随访时间为 50.5 个月（IQR31.1-80.3）。对我们的临床终点进行了事件时间分析。
在队列中，117 名患者（18.4%）患有中高危疾病。总体而言，5 年和 10 年全因生存率分别为 98%和 94%。5 年和 10 年累积无转移生存率分别为 99%和 98%。迄今为止，未观察到癌症特异性死亡。5 年和 10 年时，无干预总体自由率分别为 61%和 49%。5 年和 10 年时，无主动监测失败（定义为局部治疗后有治愈意向的转移或生化失败）的总体累积自由率分别为 97%和 91%。21 名患者（9.9%）在延迟治疗后发生生化失败，5 年无进展概率为 92%。与低危疾病患者相比，中高危癌症患者在转移、监测失败或有治愈意向的干预方面没有差异。然而，高风险患者的全因死亡率显著增加，这可能反映了患者选择因素。这些结论可能受到事件数量少和研究持续时间的限制。
接受主动监测的局限性前列腺癌患者无论基线风险如何，主动监测失败、前列腺癌特异性死亡率和转移的发生率均较低。
