Koo Kyo Chul, Lee Kwang Suk, Jeong Jae Yong, Choi In Young, Lee Ji Youl, Hong Jun Hyuk, Kim Choung-Soo, Lee Hyun Moo, Hong Sung Kyu, Byun Seok-Soo, Lee Seung Hwan, Rha Koon Ho, Chung Byung Ha
Department of Urology, Yonsei University College of Medicine.
Graduate School of Management and Policy, The Catholic University of Korea.
Jpn J Clin Oncol. 2017 Oct 1;47(10):981-985. doi: 10.1093/jjco/hyx101.
A web-based multicenter Korean Prostate Cancer Database (K-CaP) was established to provide urologists with information on Korean prostate cancer (PCa) patients treated with radical prostatectomy (RP). We utilized the K-CaP registry to identify pathological features and oncological outcomes of Korean PCa patients eligible for active surveillance (AS).
The K-CaP registry consisted of 6415 patients who underwent RP from May 2001 to April 2013 at five institutions. Preoperative clinicopathological data were collected to identify patients who were eligible for at least one contemporary AS protocol. Patients who had received neoadjuvant androgen deprivation therapy or a 5α-reductase inhibitor, who had <10 total biopsy cores, or who had incomplete data were excluded. Biochemical recurrence (BCR) was defined as prostate-specific antigen (PSA) level ≥0.2 ng/ml following RP.
A total of 560 patients were identified, and the median follow-up period was 52.0 (interquartile range, 39.0-67.3) months. Pathologically insignificant PCa, defined as organ-confined disease with Gleason score ≤6 was observed in 314 (56.1%) patients. Pathological upgrading (Gleason score ≥7) and upstaging (≥pT3) were observed in 237 (42.3%) and 75 (13.4%) patients, respectively. Unfavorable disease (extracapsular extension, seminal vesicle invasion, or Gleason score ≥8) was observed in 85 (15.2%) patients. PSA density ≤0.2 ng/ml/cc and maximal single core involvement ≤20% were revealed as independent preoperative predictors of pathologically insignificant PCa.
Contemporary Western AS protocols unreliably predict pathologically insignificant PCa in Korean men. Korean men may harbor more aggressive PCa features than Western men, and thus, a more stringent AS protocol is needed.
基于网络的多中心韩国前列腺癌数据库（K-CaP）已建立，旨在为泌尿外科医生提供接受根治性前列腺切除术（RP）治疗的韩国前列腺癌（PCa）患者的信息。我们利用K-CaP登记处来确定符合主动监测（AS）条件的韩国PCa患者的病理特征和肿瘤学结局。
K-CaP登记处包括2001年5月至2013年4月在五家机构接受RP的6415例患者。收集术前临床病理数据以确定符合至少一种当代AS方案条件的患者。接受新辅助雄激素剥夺治疗或5α还原酶抑制剂治疗、活检芯总数<10个或数据不完整的患者被排除。生化复发（BCR）定义为RP后前列腺特异性抗原（PSA）水平≥0.2 ng/ml。
共确定560例患者，中位随访期为52.0（四分位间距，39.0 - 67.3）个月。314例（56.1%）患者观察到病理上无意义的PCa，定义为Gleason评分≤6的器官局限性疾病。分别有237例（42.3%）和75例（13.4%）患者观察到病理升级（Gleason评分≥7）和分期升级（≥pT3）。85例（15.2%）患者观察到不良疾病（包膜外侵犯、精囊侵犯或Gleason评分≥8）。PSA密度≤0.2 ng/ml/cc和最大单芯受累≤20%被揭示为病理上无意义的PCa的独立术前预测因素。
当代西方AS方案在预测韩国男性病理上无意义的PCa方面不可靠。韩国男性可能比西方男性具有更具侵袭性的PCa特征，因此，需要更严格的AS方案。
