Wu Xiangkun, Lv Daojun, Eftekhar Md, Cai Chao, Zhao Zhijian, Gu Di, Liu Yongda
Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Guangdong Key Laboratory of Urology, Guangzhou Institute of Urology, Guangzhou, China.
Transl Androl Urol. 2021 Jan;10(1):154-163. doi: 10.21037/tau-20-994.
Active surveillance or watchful waiting (AS/WW) is increasingly being used as an alternative strategy to radical prostatectomy or radiation therapy for appropriately selected patients with prostate cancer (PCa). However, the prognosis of low-risk and selective intermediate-risk PCa patients after AS/WW is poorly defined. In this study we reviewed the patients registered in the Surveillance, Epidemiology, and End Results (SEER) Program to establish a competing risk nomogram for the prediction of prostate cancer-specific mortality (PCSM).
The information of patients undergoing AS/WW in the SEER program from 2004 to 2015 was obtained. All patients were ISUP (International Society of Urological Pathology) grade 1 or 2 PCa and also fulfilled the National Comprehensive Cancer Network's definition of low-risk PCa [prostate specific antigen (PSA) <10 ng/mL and cT2aN0M0 or less)]. A competing risk nomogram was used to analyze the association of tumor characteristics with PCSM and non-PCSM among the PCa patients with AS/WW. All cases were randomly divided into a training cohort and a validation cohort (1:1). A competing risk nomogram was constructed to predict PCSM in PCa patients with AS/WW. The performance of the PCSM nomogram was evaluated using the concordance index (C-index) and calibration curve.
A total of 30,538 PCa patients were identified as low risk or selective intermediate risk with AS/WW. The 10-year cumulative incidence of death from prostate cancer and death from other cause were 2.8% (95% CI: 2.4-3.1%) and 19.3% (95% CI: 17.8-20.5%), respectively. Variables associated with PCSM included age, marital status, PSA, and ISUP grade. The PCSM nomogram had a good performance in both the training and validation cohorts, with a C-index of 0.744 (95% CI: 0.700-0.781, P<0.001) and 0.738 (95% CI: 0.700-0.777, P<0.001), respectively.
Overall, the prognosis was favorable for the low- and selective intermediate-risk PCa patients with AS/WW. The competing risk nomogram yielded a good performance in identifying subgroups of patients with a higher risk of PCSM and potential candidates for AS/WW.
主动监测或观察等待（AS/WW）正越来越多地被用作对适当选择的前列腺癌（PCa）患者进行根治性前列腺切除术或放射治疗的替代策略。然而，低风险和选择性中风险PCa患者在AS/WW后的预后尚不明确。在本研究中，我们回顾了监测、流行病学和最终结果（SEER）计划中登记的患者，以建立一个用于预测前列腺癌特异性死亡率（PCSM）的竞争风险列线图。
获取了2004年至2015年SEER计划中接受AS/WW的患者信息。所有患者均为国际泌尿病理学会（ISUP）1级或2级PCa，并且也符合美国国立综合癌症网络对低风险PCa的定义[前列腺特异性抗原（PSA）<10 ng/mL且cT2aN0M0或更低]。使用竞争风险列线图分析AS/WW的PCa患者中肿瘤特征与PCSM和非PCSM的关联。所有病例随机分为训练队列和验证队列（1:1）。构建竞争风险列线图以预测接受AS/WW的PCa患者的PCSM。使用一致性指数（C指数）和校准曲线评估PCSM列线图的性能。
共有30538例PCa患者被确定为低风险或选择性中风险并接受AS/WW。前列腺癌死亡和其他原因死亡的10年累积发生率分别为2.8%（95%CI：2.4 - 3.1%）和19.3%（95%CI：17.8 - 20.5%）。与PCSM相关的变量包括年龄、婚姻状况、PSA和ISUP分级。PCSM列线图在训练队列和验证队列中均表现良好，C指数分别为0.744（95%CI：0.700 - 0.781；P<0.001）和0.738（95%CI：0.700 - 0.777；P<0.001）。
总体而言，但对于接受AS/WW的低风险和选择性中风险PCa患者，预后良好。竞争风险列线图在识别PCSM风险较高的患者亚组和AS/WW的潜在候选者方面表现良好。
