Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Urology. 2020 Oct;144:164-170. doi: 10.1016/j.urology.2020.06.061. Epub 2020 Jul 15.
To evaluate the efficacy of combined MRI-targeted plus systematic 12-core biopsy (Cbx) to aid in the selection of patients for active surveillance (AS).
From July 2007 to January 2020, patients with Gleason Grade Group (GG) 1 or GG 2 prostate cancer were referred to our center for AS consideration. All patients underwent an MRI and confirmatory combined MRI-targeted plus systematic biopsy (Cbx), and AS outcomes based on Cbx results were compared. Cox regression was used to identify predictors of AS failure, defined as progression to ≥ GG3 disease on follow-up biopsies.
Of 579 patients referred for AS, 79.3% (459/579) and 20.7% (120/579) had an initial diagnosis of GG1 and GG2 disease, respectively. Overall, 43.2% of patients (250/579) were upgraded on confirmatory Cbx, with 19.2% (111/579) upgraded to ≥ GG3. For the 226 patients followed on AS, 32.7% (74/226) had benign, 45.6% (103/226) had GG1, and 21.7% (49/226) had GG2 results on confirmatory Cbx. In total, 28.8% (65/226) of patients eventually progressed to ≥ GG3, with a median time to AS failure of 89 months. The median time from confirmatory Cbx to AS failure for the negative, GG1, and GG2 groups were 97, 97, and 32 months, respectively (p < .001). On multivariable regression, only age (hazard ratio 1.06 [1.02-1.11], p < .005) and GG on confirmatory Cbx (hazard ratio 2.75 [1.78-4.26], p < .005) remained as positive predictors of AS failure.
The confirmatory combined MRI-targeted plus systematic biopsy provides useful information for the risk stratification of patients at the time of AS enrollment.
评估 MRI 靶向联合系统 12 针活检（Cbx）在辅助选择主动监测（AS）患者中的疗效。
2007 年 7 月至 2020 年 1 月，我们中心对 Gleason 分级组（GG）1 或 GG 2 前列腺癌患者进行了转诊，以考虑 AS。所有患者均行 MRI 检查和确认性 MRI 靶向联合系统活检（Cbx），并比较基于 Cbx 结果的 AS 结果。Cox 回归用于识别 AS 失败的预测因素，AS 失败定义为随访活检进展为≥GG3 疾病。
在 579 例转诊接受 AS 的患者中，79.3%（459/579）和 20.7%（120/579）患者的初始诊断分别为 GG1 和 GG2 疾病。总体而言，43.2%（250/579）的患者在确认性 Cbx 中升级，其中 19.2%（111/579）升级至≥GG3。在 226 例接受 AS 随访的患者中，74 例（74/226）的活检结果为良性，45.6%（103/226）为 GG1，21.7%（49/226）为 GG2。总的来说，28.8%（65/226）的患者最终进展为≥GG3，AS 失败的中位时间为 89 个月。阴性、GG1 和 GG2 组从确认性 Cbx 到 AS 失败的中位时间分别为 97、97 和 32 个月（p<0.001）。多变量回归分析显示，只有年龄（危险比 1.06[1.02-1.11]，p<0.005）和确认性 Cbx 的 GG（危险比 2.75[1.78-4.26]，p<0.005）是 AS 失败的阳性预测因素。
确认性联合 MRI 靶向联合系统活检为 AS 入组时患者的风险分层提供了有用的信息。
