Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
World J Urol. 2019 Mar;37(3):469-479. doi: 10.1007/s00345-018-2396-2. Epub 2018 Jul 10.
Recent studies demonstrated ongoing inverse stage migration in prostate cancer (PCa) patients towards more advanced and unfavorable tumors. The USPSTF grade D recommendation may impact this trend in North American patients. We assessed contemporary stage migration and treatment trends in a large North American cohort diagnosed with PCa 2009-2014.
Time-trend analyses were performed in patients within the Surveillance, Epidemiology, and End Results database, with complete data of clinical tumor stage, biopsy Gleason score, and validated PSA values, resulting in 211,645 assessable patients. Patients were stratified according to their different treatment methods [radical prostatectomy (RP), radiotherapy (RT), and no local treatment (NLT)] and according to clinical and pathological risk stratification (D'Amico and CAPRA-S score).
Over time, proportions of D'Amico low-risk (LR) decreased, with an increase in intermediate-to-high-risk (IR/HR) patients. These trends were more distinct in men ≥ 70 years. NLT proportions increased, most notably in D'Amico LR and/or older patients. Conversely, RP proportions remained stable in younger HR and increased in older HR patients. Similar patterns were demonstrated in the RP-treated subgroup: D'Amico HR, pT3, and/or lymph-node invasion or CAPRA-S HR proportions increased from 23.5 to 30.8, 24.3 to 32.9, and 10.7 to 16.3% (each p ≤ 0.015).
Inverse stage migration with increase of unfavorable PCa continues in most contemporary North American patients. However, a paradigm shift to treat LR patients with less invasive methods (NLT) was demonstrated. Contrary, HR patients increasingly undergo LT. Future studies with long-term follow-up might answer if inverse stage migration vs. treatment trends translate into different PCa metastases/mortality rates vs. proposed NLT benefits, particularly related to USPSTF-recommended reduced PSA screening.
最近的研究表明，前列腺癌（PCa）患者的肿瘤分期呈逆向迁移趋势，向更晚期和预后不良的肿瘤发展。USPSTF 等级 D 的推荐可能会影响北美患者的这一趋势。我们评估了 2009-2014 年在北美大型队列中诊断为 PCa 的患者的当代肿瘤分期迁移和治疗趋势。
在 Surveillance, Epidemiology, and End Results 数据库中进行时间趋势分析，这些患者具有完整的临床肿瘤分期、活检 Gleason 评分和经过验证的 PSA 值数据，共评估了 211645 例可评估患者。根据不同的治疗方法（根治性前列腺切除术[RP]、放疗[RT]和局部无治疗[NLT]）和临床及病理危险分层（D'Amico 和 CAPRA-S 评分）对患者进行分层。
随着时间的推移，D'Amico 低危（LR）患者的比例下降，中高危（IR/HR）患者的比例增加。这种趋势在≥70 岁的男性中更为明显。NLT 的比例增加，在 D'Amico LR 和/或老年患者中最为显著。相反，年轻 HR 患者中 RP 的比例保持稳定，而老年 HR 患者中 RP 的比例增加。在接受 RP 治疗的亚组中也观察到类似的模式：D'Amico HR、pT3 和/或淋巴结侵犯或 CAPRA-S HR 的比例从 23.5%增加到 30.8%、24.3%增加到 32.9%和 10.7%增加到 16.3%（p≤0.015）。
在大多数当代北美患者中，肿瘤分期呈逆向迁移趋势，且前列腺癌的预后不良因素增加。然而，我们也观察到一种治疗模式的转变，即用侵袭性较小的方法（NLT）治疗 LR 患者。相反，HR 患者越来越多地接受 LT。未来具有长期随访的研究可能会回答，肿瘤分期逆向迁移与治疗趋势是否会转化为不同的前列腺癌转移/死亡率，以及与 USPSTF 推荐的减少 PSA 筛查相关的 NLT 获益。
