过去十年中前列腺癌根治术后向高危前列腺癌的转移。
Migration in last decade to high-risk prostate cancer after radical prostatectomy.
作者信息
Patard P-M, Roumiguié M, Prudhomme T, Doumerc N, Thoulouzan M, Gamé X, de la Taille A, Rischmann P, Soulié M, Salomon L, Beauval J-B
机构信息
Department of urology, andrology and renal transplantation, CHU Rangueil, Paul-Sabatier university, 1, avenue J Poulhès, 31059 Toulouse cedex, France.
Department of urology, Henri-Mondor Hospital, Assistance-Publique Hôpitaux de Paris, 51, avenue du Maréchal de Lattre-de-Tassigny, 94010 Créteil, France.
出版信息
Prog Urol. 2019 Jan;29(1):29-35. doi: 10.1016/j.purol.2018.09.008. Epub 2018 Oct 15.
OBJECTIVE
There is controversy around prostate cancer (PCa) screening through the use of PSA, due to the risk of overtreatment. The current trend observed in various European and American studies is a decrease in the number of radical prostatectomy (RP) in low-risk PCa and an increase for intermediate or locally advanced diseases. The objective of this study was to observe the migration of the pathological stages from radical prostatectomy (RP) over 10 years in France through 2 French centers.
METHODS
It was a multicentric retrospective study, where all the RP realized in 2 French tertiary centers, in a laparoscopic or retropubic approach for each of the years 2005, 2010 and 2015 were included. Preoperative data (age, PSA, clinical stage, number of positive biopsies, Gleason biopsy score) and postoperative data (pTNM, pathological Gleason score (pGS)) were analyzed and compared.
RESULTS
In all, 1282 RP were realized (503 in 2005, 403 in 2010, 376 in 2015). Respectively between 2005, 2010, 2015 the average number of positive biopsy increased significantly from 2.30 vs. 2.88 vs. 5.3 (P=0.0001). The distribution of D'Amico's risk evolves with time: low-risk: 49.9 vs. 44.4 vs. 15.7% (P=0.0001); intermediate risk: 40.95 vs. 43.92 vs. 64.1% (P=0.0001) and high-risk: 9.15 vs. 11.66 vs. 20.2% (P=0.0001) between 2005, 2010 and 2015 respectively. pGS evolved to higher score with SG<7: 22.8 vs. 29.9 vs. 7.1% et SG≥7: 77.2 vs. 70.1 vs. 92.9% (P=0.001). Also, pTNM increased to non-organ-confined disease: pT2: 66.9 vs. 51.9 vs. 48.7%; pT3: 33.1 vs. 48.1 vs. 51.3% (P=0.0001).
CONCLUSION
This study showed a change in the management of PCa since new recommendations from medical authorities about PSA screening and evolving of conservative treatment. Number of RP increase for higher risk PCa. This change corresponds to better patient selection for RP: decrease for low-risk and increase for high-risk organ-confined disease.
LEVEL OF EVIDENCE
目的
由于存在过度治疗的风险，通过前列腺特异性抗原（PSA）进行前列腺癌（PCa）筛查存在争议。欧美各项研究中观察到的当前趋势是，低风险PCa患者的根治性前列腺切除术（RP）数量减少，而中危或局部晚期疾病患者的RP数量增加。本研究的目的是通过法国的两个中心观察法国10年间接受根治性前列腺切除术（RP）患者的病理分期变化情况。
方法
这是一项多中心回顾性研究，纳入了2005年、2010年和2015年在法国两个三级中心采用腹腔镜或耻骨后途径实施的所有RP手术。分析并比较术前数据（年龄、PSA、临床分期、阳性活检数量、活检Gleason评分）和术后数据（pTNM、病理Gleason评分（pGS））。
结果
共实施了1282例RP手术（2005年503例，2010年403例，2015年376例）。2005年、2010年、2015年阳性活检的平均数量分别显著增加，从2.30增至2.88再增至5.3（P = 0.0001）。达米科风险分类的分布随时间变化：低风险：分别为49.9%、44.4%、15.7%（P = 0.0001）；中风险：分别为40.95%、43.92%、64.1%（P = 0.0001）；高风险：分别为9.15%、11.66%、20.2%（P = 0.0001）。pGS随时间发展至更高评分，GS<7：分别为22.8%、29.9%、7.1%；GS≥7：分别为77.2%、70.1%、92.9%（P = 0.001）。此外，pTNM进展为非器官局限性疾病：pT2：分别为66.9%、51.9%、48.7%；pT3：分别为33.1%、48.1%、51.3%（P = 0.0001）。
结论
本研究显示，自医学权威机构对PSA筛查提出新建议以及保守治疗方法不断发展以来，PCa的治疗管理发生了变化。高风险PCa患者的RP数量增加。这一变化对应着RP患者选择的优化：低风险患者数量减少，高风险器官局限性疾病患者数量增加。
证据级别
3级
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