Jeon Hwang Gyun, Yoo Jae Ho, Jeong Byong Chang, Seo Seong Il, Jeon Seong Soo, Choi Han-Yong, Lee Hyun Moo, Ferrari Michelle, Brooks James D, Chung Benjamin I
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Urology, Stanford University Medical Center, Stanford, CA, United States of America.
PLoS One. 2017 Nov 14;12(11):e0186026. doi: 10.1371/journal.pone.0186026. eCollection 2017.
To investigate the impact of race on the risk of pathological upgrading and upstaging at radical prostatectomy (RP) in an Asian (Korean) and Western (Caucasian) cohort eligible for active surveillance (AS).
We performed a retrospective cohort study of 854 patients eligible for AS who underwent RP in United States (n = 261) and Korea (n = 593) between 2006 and 2015. After adjusting for age, PSA level, and prostate volume, we utilized multivariate logistic regression analysis to assess the effect of race on upgrading or upstaging.
There were significant differences between Caucasian and Korean patients in terms of age at surgery (60.2 yr. vs. 64.1 yr.), PSA density (0.115 ng/mL/mL vs. 0.165 ng/mL/mL) and mean number of positive cores (3.5 vs. 2.4), but not in preoperative PSA values (5.11 ng/mL vs. 5.05 ng/mL). The rate of upstaging from cT1 or cT2 to pT3 or higher was not significantly different between the two cohorts (8.8% vs. 11.0%, P = 0.341). However, there were higher rates of upgrading to high-grade cancer (Gleason 4+3 or higher) in Korean patients (9.1%) when compared to Caucasian counterparts (2.7%) (P = 0.003). Multivariate logistic regression analysis showed that age (OR 1.07, P < 0.001) and smaller prostate volume (OR 0.97, P < 0.001), but not race, were significantly associated with upstaging or upgrading.
There were no differences in rates of upgrading or upstaging between Caucasian and Korean men eligible for active surveillance.
在符合主动监测（AS）条件的亚洲（韩国）和西方（白种人）队列中，研究种族对根治性前列腺切除术（RP）时病理升级和分期上升风险的影响。
我们对2006年至2015年间在美国（n = 261）和韩国（n = 593）接受RP的854例符合AS条件的患者进行了一项回顾性队列研究。在调整年龄、PSA水平和前列腺体积后，我们采用多因素逻辑回归分析来评估种族对升级或分期上升的影响。
白种人和韩国患者在手术年龄（60.2岁对64.1岁）、PSA密度（0.115 ng/mL/mL对0.165 ng/mL/mL）和阳性核心平均数量（3.5对2.4）方面存在显著差异，但术前PSA值无差异（5.11 ng/mL对5.05 ng/mL）。两个队列中从cT1或cT2分期上升至pT3或更高分期的发生率无显著差异（8.8%对11.0%，P = 0.341）。然而，与白种人患者（2.7%）相比，韩国患者升级为高级别癌症（Gleason 4+3或更高）的发生率更高（9.1%）（P = 0.003）。多因素逻辑回归分析显示，年龄（OR 1.07，P < 0.001）和较小的前列腺体积（OR 0.97，P < 0.001），而非种族，与分期上升或升级显著相关。
符合主动监测条件的白种人和韩国男性在升级或分期上升发生率方面无差异。
