Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts.
Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts.
Cancer. 2019 Sep 15;125(18):3164-3171. doi: 10.1002/cncr.32202. Epub 2019 May 31.
Certain patients with intermediate-risk prostate cancer (PCa) may be appropriate candidates for active surveillance (AS). In the current study, the authors sought to characterize AS use and early mortality outcomes for patients with intermediate-risk PCa in the United States.
The novel Surveillance, Epidemiology, and End Results Active Surveillance/Watchful Waiting database identified 52,940 men diagnosed with National Comprehensive Cancer Network intermediate-risk PCa (cT2b-c, Gleason score of 7, or a prostate-specific antigen level of 10-20 ng/mL) and actively managed (AS, radiotherapy, or radical prostatectomy) from 2010 through 2015. The Cuzick test assessed AS time trends, and logistic multivariable regression characterized features associated with AS. Fine-Gray and Cox modeling determined PCa-specific mortality (PCSM) and overall survival, respectively.
The rate of AS increased from 3.7% in 2010 to 7.3% in 2015, and from 7.2% to 11.7% among men aged ≥70 years. Among men with favorable and unfavorable intermediate-risk disease, the use of AS increased from 7.2% to 14.9% and from 2.2% to 3.8%, respectively (all P value for trend, <.001). The mean age of those patients managed with AS decreased from 69.9 years to 67.9 years (P = .0004). Factors found to be associated with AS included favorable risk disease; black race; higher socioeconomic status; older age; and diagnosis in the West, Northwest, or Midwest regions of the United States. The 5-year PCSM rate was comparable to AS versus treatment among patients with low-risk and favorable intermediate-risk disease, but was worse with AS among those with unfavorable intermediate-risk disease (PCSM, 1.3% vs 0.5%; adjusted hazard ratio, 2.48 [95% CI, 1.11-5.50; P = .026]) and intermediate-risk disease overall (PCSM, 1.1% vs 0.4%; adjusted hazard ratio, 2.34 [95% CI, 1.25-4.37; P = .008]).
The use of AS for patients with intermediate-risk PCa is increasing across the United States, particularly for older men and those with favorable intermediate-risk disease. Early estimates of cancer-specific and overall mortality rates are low with AS, although significantly higher compared with treatment.
某些患有中危前列腺癌（PCa）的患者可能是主动监测（AS）的合适人选。在目前的研究中，作者试图描述美国中危 PCa 患者中 AS 的使用情况和早期死亡率结果。
新的监测、流行病学和最终结果主动监测/观察等待数据库确定了 52940 名被诊断患有国家综合癌症网络中危 PCa（cT2b-c、Gleason 评分 7 或前列腺特异性抗原水平 10-20ng/ml）并从 2010 年至 2015 年进行主动管理（AS、放疗或根治性前列腺切除术）的男性。Cuzick 检验评估了 AS 的时间趋势，逻辑多变量回归描述了与 AS 相关的特征。精细灰色和 Cox 模型分别确定了前列腺癌特异性死亡率（PCSM）和总体生存率。
AS 的比例从 2010 年的 3.7%增加到 2015 年的 7.3%，在 70 岁及以上的男性中从 7.2%增加到 11.7%。在具有有利和不利中危疾病的男性中，AS 的使用比例从 7.2%增加到 14.9%和从 2.2%增加到 3.8%（所有趋势 P 值，<.001）。接受 AS 治疗的患者的平均年龄从 69.9 岁降至 67.9 岁（P =.0004）。与 AS 相关的因素包括有利的风险疾病；黑种人；较高的社会经济地位；年龄较大；以及在美国西部、西北部或中西部地区诊断。在低危和有利中危疾病患者中，AS 与治疗的 5 年 PCSM 率相当，但在不利中危疾病患者中（PCSM，1.3% vs 0.5%；调整后的危险比，2.48 [95%CI，1.11-5.50；P =.026]）和中危疾病整体（PCSM，1.1% vs 0.4%；调整后的危险比，2.34 [95%CI，1.25-4.37；P =.008]），AS 的 PCSM 率更差。
在美国，AS 用于治疗中危 PCa 的使用率正在上升，特别是在老年男性和具有有利中危疾病的男性中。尽管与治疗相比，AS 的癌症特异性和总体死亡率的早期估计值较低，但差异具有统计学意义。
