Ganesan Vishnu, Dai Charles, Nyame Yaw A, Greene Daniel J, Almassi Nima, Hettel Daniel, Zabell Joseph, Arora Hans, Haywood Samuel, Crane Alice, Reichard Chad, Zampini Anna, Elshafei Ahmed, Stein Robert J, Fareed Khaled, Jones J Stephen, Gong Michael, Stephenson Andrew J, Klein Eric A, Berglund Ryan K
Lerner College of Medicine, Cleveland Clinic, Cleveland, OH.
Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH.
Urology. 2017 Sep;107:184-189. doi: 10.1016/j.urology.2017.06.014. Epub 2017 Jun 15.
To examine the association between absence of disease on confirmatory biopsy and risk of pathologic reclassification in men on active surveillance (AS).
Men with grade groups 1 and 2 disease on AS between 2002 and 2015 were identified who received a confirmatory biopsy within 1 year of diagnosis and ≥3 biopsies overall. The primary outcomes were pathologic reclassification by grade (any increase in primary Gleason pattern or Gleason score) or volume (>33% of sampled cores involved or increase in the number of cores with >50% involvement). The effect of a negative confirmatory biopsy survival was evaluated using Kaplan-Meier analysis and a Cox proportional hazards modeling.
Out of 635 men, 224 met inclusion criteria (median follow-up: 55.8 months). A total of 111 men (49.6%) had a negative confirmatory biopsy. Decreased grade reclassification (69.7% vs 83.9%; P = .01) and volume reclassification (66.3% vs 87.4%; P = .004) was seen at 5 years for men with a negative confirmatory biopsy compared with those with a positive biopsy. On adjusted analysis, a negative confirmatory biopsy was associated with a decreased risk of grade reclassification (hazard ratio, 0.51; 95% confidence interval, 0.28-0.94; P = .03) and volume reclassification (hazard ratio, 0.32; 95% confidence interval, 0.17-0.61; P = .0006) at a median of 4.7 years.
Absence of cancer on the confirmatory biopsy is associated with a significant decrease in rate of grade and volume reclassification among men on AS. This information may be used to better counsel men on AS.
探讨确诊活检未发现疾病与接受主动监测（AS）的男性病理重新分类风险之间的关联。
确定2002年至2015年间接受AS且疾病分级为1级和2级的男性，他们在诊断后1年内接受了确诊活检，且总共进行了≥3次活检。主要结局为按分级进行的病理重新分类（主要Gleason模式或Gleason评分的任何增加）或体积（>33%的采样核心受累或>50%受累核心数量增加）。使用Kaplan-Meier分析和Cox比例风险模型评估确诊活检阴性对生存的影响。
635名男性中，224名符合纳入标准（中位随访时间：55.8个月）。共有111名男性（49.6%）确诊活检为阴性。与活检阳性的男性相比，确诊活检阴性的男性在5年时分级重新分类（69.7%对83.9%；P = 0.01）和体积重新分类（66.3%对87.4%；P = 0.004）有所减少。在调整分析中，确诊活检阴性与分级重新分类风险降低（风险比，0.51；95%置信区间，0.28 - 0.94；P = 0.03）和体积重新分类风险降低（风险比，0.32；95%置信区间，0.17 - 0.61；P = 0.0006）相关，中位时间为4.7年。
确诊活检未发现癌症与接受AS的男性分级和体积重新分类率显著降低相关。该信息可用于更好地为接受AS的男性提供咨询。
