四种前列腺癌主动监测队列中活检升级的对比分析。
Comparative Analysis of Biopsy Upgrading in Four Prostate Cancer Active Surveillance Cohorts.
机构信息
From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee.
出版信息
Ann Intern Med. 2018 Jan 2;168(1):1-9. doi: 10.7326/M17-0548. Epub 2017 Nov 28.
BACKGROUND
Active surveillance (AS) is increasingly accepted for managing low-risk prostate cancer, yet there is no consensus about implementation. This lack of consensus is due in part to uncertainty about risks for disease progression, which have not been systematically compared or integrated across AS studies with variable surveillance protocols and dropout to active treatment.
OBJECTIVE
To compare risks for upgrading from a Gleason score (GS) of 6 or less to 7 or more across AS studies after accounting for differences in surveillance intervals and competing treatments and to evaluate tradeoffs of more versus less frequent biopsies.
DESIGN
Joint statistical model of longitudinal prostate-specific antigen (PSA) levels and risks for biopsy upgrading.
SETTING
Johns Hopkins University (JHU); Canary Prostate Active Surveillance Study (PASS); University of California, San Francisco (UCSF); and University of Toronto (UT) AS studies.
PATIENTS
2576 men aged 40 to 80 years with a GS between 2 and 6 and clinical stage T1 or T2 prostate cancer enrolled between 1995 and 2014.
MEASUREMENTS
PSA levels and biopsy GSs.
RESULTS
After variable surveillance intervals and competing treatments were accounted for, estimated risks for biopsy upgrading were similar in the PASS and UT studies but higher in UCSF and lower in JHU studies. All cohorts had a delay of 3 to 5 months in detecting upgrading with biennial biopsies starting after a first confirmatory biopsy versus annual biopsies.
LIMITATION
The model does not account for possible misclassification of biopsy GS.
CONCLUSION
Men in different AS studies have different risks for biopsy upgrading after variable surveillance protocols and competing treatments are accounted for. Despite these differences, the consequences of more versus less frequent biopsies seem to be similar across cohorts. Biennial biopsies seem to be an acceptable alternative to annual biopsies.
PRIMARY FUNDING SOURCE
National Cancer Institute.
背景
主动监测（AS）越来越被接受用于管理低风险前列腺癌，但在实施方面仍存在分歧。这种分歧部分源于对疾病进展风险的不确定性，这些风险在具有不同监测方案和因主动治疗而脱落的 AS 研究中并未得到系统比较或综合评估。
目的
在考虑监测间隔和竞争治疗差异的情况下，比较不同 AS 研究中从 GS 评分 6 或更低升级为 7 或更高的风险，并评估更频繁与更不频繁活检的利弊。
设计
纵向前列腺特异性抗原（PSA）水平和活检升级风险的联合统计模型。
地点
约翰霍普金斯大学（JHU）；Canary 前列腺主动监测研究（PASS）；加州大学旧金山分校（UCSF）；多伦多大学（UT）AS 研究。
患者
1995 年至 2014 年间，年龄在 40 至 80 岁之间、GS 介于 2 至 6 之间、临床分期为 T1 或 T2 的前列腺癌患者共 2576 名。
测量指标
PSA 水平和活检 GS。
结果
在考虑了可变监测间隔和竞争治疗后，PASS 和 UT 研究中的估计活检升级风险相似，但 UCSF 研究中的风险更高，JHU 研究中的风险更低。所有队列在首次确认性活检后进行两年一次的活检时，与每年进行活检相比，发现升级的时间都延迟了 3 至 5 个月。
局限性
该模型未考虑活检 GS 可能存在的误诊。
结论
在考虑了不同的监测方案和竞争治疗后，不同 AS 研究中的男性具有不同的活检升级风险。尽管存在这些差异，但在不同队列中，更频繁与更不频繁活检的后果似乎相似。两年一次的活检似乎是每年一次活检的可接受替代方案。
主要资金来源
美国国立卫生研究院。
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