Tsang C F, Tsu J Hl, Lai T Ct, Wong K W, Ho B Sh, Ng A Tl, Ma W K, Yiu M K
Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
Hong Kong Med J. 2017 Dec;23(6):609-15. doi: 10.12809/hkmj166194. Epub 2017 Oct 13.
Active surveillance is one of the therapeutic options for the management of patients with low-risk prostate cancer. This study compared the performance of six different active surveillance protocols for prostate cancer in the Chinese population.
Patients who underwent radical prostatectomy for prostate cancer from January 1998 to December 2012 at a university teaching hospital in Hong Kong were reviewed. Six active surveillance protocols were applied to the cohort. Statistical analyses were performed to compare the probabilities of missing unfavourable pathological outcome. The sensitivity and specificity of each protocol in identifying low-risk disease were compared.
During the study period, 287 patients were included in the cohort. Depending on different active surveillance protocols used, extracapsular extension, seminal vesicle invasion, pathological T3 disease, and upgrading of Gleason score were present on final pathology in 3.3%-17.1%, 0%-3.3%, 3.3%-19.1%, and 20.6%-34.5% of the patients, respectively. The University of Toronto protocol had a higher rate of extracapsular extension at 17.1% and pathological T3 disease at 19.1% on final pathology than the more stringent protocols from John Hopkins (3.3% extracapsular extension, P=0.05 and 3.3% pathological T3 disease, P=0.03) and Prostate Cancer Research International: Active Surveillance (PRIAS; 8.0% pathological T3 disease, P=0.04). The Royal Marsden protocol had a higher rate of upgrading of Gleason score at 34.5% compared with the more stringent protocol of PRIAS at 20.6% (P=0.04). The specificities in identifying localised disease and low-risk histology among different active surveillance protocols were 59%-98% and 58%-94%, respectively. The John Hopkins active surveillance protocol had the highest specificity in both selecting localised disease (98%) and low-risk histology (94%).
Active surveillance protocols based on prostate-specific antigen and Gleason score alone or including Gleason score of 3+4 may miss high-risk disease and should be used cautiously. The John Hopkins and PRIAS protocols are highly specific in identifying localised disease and low-risk histology.
主动监测是低风险前列腺癌患者治疗的选择之一。本研究比较了六种不同的前列腺癌主动监测方案在中国人群中的表现。
回顾了1998年1月至2012年12月在香港一所大学教学医院接受前列腺癌根治术的患者。对该队列应用了六种主动监测方案。进行统计分析以比较遗漏不良病理结果的概率。比较了每种方案在识别低风险疾病方面的敏感性和特异性。
在研究期间，该队列纳入了287例患者。根据所使用的不同主动监测方案，最终病理显示，分别有3.3%-17.1%的患者出现包膜外侵犯、0%-3.3%的患者出现精囊侵犯、3.3%-19.1%的患者出现病理T3期疾病以及20.6%-34.5%的患者出现Gleason评分升级。多伦多大学方案在最终病理上包膜外侵犯率较高，为17.1%，病理T3期疾病率为19.1%，高于约翰霍普金斯大学更严格的方案（包膜外侵犯3.3%，P=0.05；病理T3期疾病3.3%，P=0.03）和国际前列腺癌研究组织：主动监测（PRIAS；病理T3期疾病8.0%，P=0.04）。皇家马斯登方案的Gleason评分升级率为34.5%，高于PRIAS更严格方案的20.6%（P=0.04）。不同主动监测方案在识别局限性疾病和低风险组织学方面的特异性分别为59%-98%和58%-94%。约翰霍普金斯主动监测方案在选择局限性疾病（98%）和低风险组织学（94%）方面具有最高的特异性。
仅基于前列腺特异性抗原和Gleason评分或包括3+4的Gleason评分的主动监测方案可能会遗漏高风险疾病，应谨慎使用。约翰霍普金斯大学和PRIAS方案在识别局限性疾病和低风险组织学方面具有高度特异性。
