Service d'urologie et transplantation rénale, CHU Pellegrin, place Amelie-Raba-Léon, 33 000 Bordeaux, France.
Service d'urologie et transplantation rénale, CHU Pellegrin, place Amelie-Raba-Léon, 33 000 Bordeaux, France.
Prog Urol. 2020 Sep;30(10):532-540. doi: 10.1016/j.purol.2020.05.006. Epub 2020 Jun 24.
Prostate cancer is supposedly more aggressive among Afro-Caribbean men. There is a lack of data in this population for active surveillance. Published series are retrospective or have small samples and results are discordant. The objective was to determinate whether actual active surveillance modalities can be applied for Afro-Caribbean men by comparing their oncological outcomes with Caucasian men.
A total of 449 consecutive patients who underwent active surveillance for favorable-risk prostate cancer in two French University-Medical-Centers between 2005 and 2018: 261 in Guadeloupe, French West Indies, and 188 in Bordeaux, metropolitan France. Median follow-up was 56 months, (95% CI [32-81]) and 52 months (95% CI [30-75]), respectively (P=0.07). Curative treatment was given in case of histological, biological, or imaging progression, or upon patient demand. Primary endpoints were treatment-free, overall and specific survival. Secondary outcomes were reasons of discontinuating active surveillance, histological poor prognosis factors after prostatectomy, CAPRA-S score, biochemical-recurrence-free after treatment and metastasis-free survival. Kaplan-Meier method was used.
Median treatment free survival was 58.4 months (CI 95% [48.6-83.1]) for ACM and not reached at 120 months for CM (P=0.002). Overall survival (P=0.53), and specific survival (P=0.21) were similar in the two groups. CM were likely to have poor prognosis factor on prostatecomy piece (57 vs 30%, P=0.01). No difference for repartition of the CAPRA-S score (P=0.86), biochemical-recurrence-free (P=0.92) and metastasis-free (P=0.44) survival.
Oncological outcomes for active surveillance of Afro-Caribbean and Caucasian men were similar in terms of mortality, recurrence and metastasis in our bicentric study, showing usability of current criteria for Afro-Caribbean. The higher rate of disease progression in the Afro-Caribbean population requires close monitoring.
据推测，非裔加勒比男性的前列腺癌更具侵袭性。在该人群中，缺乏主动监测的数据。已发表的系列研究是回顾性的，或者样本量较小，结果不一致。目的是通过比较非裔加勒比男性和白种人男性的肿瘤学结果，确定是否可以为非裔加勒比男性应用实际的主动监测方式。
共有 449 名连续患者在两个法国大学医疗中心接受主动监测治疗，患有低危前列腺癌，分别为 261 名在法属瓜德罗普岛，西印度群岛和 188 名在波尔多，法国大都市。中位随访时间为 56 个月（95%CI [32-81]）和 52 个月（95%CI [30-75]）（P=0.07）。如果发生组织学、生物学或影像学进展，或者患者要求，将进行治愈性治疗。主要终点是无治疗、总体和特定生存率。次要结果是主动监测中断的原因、前列腺切除术后组织学预后不良因素、CAPRA-S 评分、治疗后生化无复发生存率和无转移生存率。使用 Kaplan-Meier 方法。
ACM 的中位无治疗生存时间为 58.4 个月（95%CI [48.6-83.1]），而 CM 则在 120 个月时未达到（P=0.002）。两组的总体生存率（P=0.53）和特定生存率（P=0.21）相似。CM 前列腺切除术后更有可能存在不良预后因素（57%对 30%，P=0.01）。CAPRA-S 评分分布（P=0.86）、生化无复发生存率（P=0.92）和无转移生存率（P=0.44）无差异。
在我们的双中心研究中，非裔加勒比和白种人男性的主动监测肿瘤学结果在死亡率、复发和转移方面相似，表明当前标准可用于非裔加勒比男性。非裔加勒比人群中疾病进展率较高需要密切监测。
