Tan Guan Hee, Finelli Antonio, Ahmad Ardalan, Wettstein Marian S, Chandrasekar Thenappan, Zlotta Alexandre R, Fleshner Neil E, Hamilton Robert J, Kulkarni Girish S, Ajib Khaled, Nason Gregory, Perlis Nathan
Division of Urology, Princess Margaret Cancer Center and Toronto General Hospital, University Health Network, Toronto, ON, Canada.
Division of Urology, University of Toronto, Toronto, ON, Canada.
Can Urol Assoc J. 2019 Aug;13(8):250-255. doi: 10.5489/cuaj.6122. Epub 2019 Aug 31.
Active surveillance (AS) is standard of care in low-risk prostate cancer (PCa). This study describes a novel total cancer location (TCLo) density metric and aims to determine its performance in predicting clinical progression (CP) and grade progression (GP).
This was a retrospective study of patients on AS after confirmatory biopsy (CBx). We excluded patients with Gleason ≥7 at CBx and <2 years followup. TCLo was the number of locations with positive cores at diagnosis (DBx) and CBx. TCLo density was TCLo/prostate volume (PV). CP was progression to any active treatment while GP occurred if Gleason ≥7 was identified on repeat biopsy or surgical pathology. Independent predictors of time to CP or GP were estimated with Cox regression. Kaplan-Meier analysis compared progression-free survival (PFS) curves between TCLo density groups. Test characteristics of TCLo density were explored with receiver operating characteristic (ROC) curves.
We included 181 patients who had CBx from 2012-2015 and met inclusion criteria. The mean age of patients was 62.58 years (standard deviation [SD] 7.13) and median followup was 60.9 months (interquartile range [IQR] 23.4). A high TCLo density score (>0.05) was independently associated with time to CP (hazard ratio [HR] 4.70; 95% confidence interval [CI] 2.62-8.42; p<0.001) and GP (HR 3.85; 95% CI 1.91-7.73; p<0.001). ROC curves showed TCLo density has greater area under the curve than number of positive cores at CBx in predicting progression.
TCLo density is able to stratify patients on AS for risk of CP and GP. With further validation, it could be added to the decision-making algorithm in AS for low-risk localized PCa.
主动监测（AS）是低风险前列腺癌（PCa）的标准治疗方法。本研究描述了一种新的全癌灶位置（TCLo）密度指标，旨在确定其在预测临床进展（CP）和分级进展（GP）方面的表现。
这是一项对确诊活检（CBx）后接受AS治疗的患者的回顾性研究。我们排除了CBx时Gleason评分≥7以及随访时间<2年的患者。TCLo是诊断活检（DBx）和CBx时阳性核心灶的位置数量。TCLo密度为TCLo/前列腺体积（PV）。CP是进展至任何积极治疗，而如果在重复活检或手术病理中发现Gleason评分≥7，则发生GP。使用Cox回归估计CP或GP发生时间的独立预测因素。Kaplan-Meier分析比较了TCLo密度组之间的无进展生存期（PFS）曲线。使用受试者工作特征（ROC）曲线探索TCLo密度的检验特征。
我们纳入了2012年至2015年期间进行CBx且符合纳入标准的181例患者。患者的平均年龄为62.58岁（标准差[SD]7.13），中位随访时间为60.9个月（四分位间距[IQR]23.4）。高TCLo密度评分（>0.05）与CP发生时间（风险比[HR]4.70；95%置信区间[CI]2.62-8.42；p<0.001）和GP（HR 3.85；95%CI 1.91-7.73；p<0.001）独立相关。ROC曲线显示，在预测进展方面，TCLo密度的曲线下面积大于CBx时阳性核心灶的数量。
TCLo密度能够对接受AS治疗的患者进行CP和GP风险分层。经过进一步验证后，它可被添加到低风险局限性PCa的AS决策算法中。
