与即刻前列腺切除术相比，主动监测一段时间后行延迟根治性前列腺切除术与二次治疗的使用无关。
Delayed radical prostatectomy after a period of active surveillance is not associated with the use of secondary treatments compared with immediate prostatectomy.
机构信息
Department of Urology, Wayne State University, Detroit, Michigan, USA.
Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.
出版信息
Prostate. 2022 Feb;82(3):323-329. doi: 10.1002/pros.24277. Epub 2021 Dec 2.
BACKGROUND
We evaluated the use of secondary treatments in men with grade group (GG) 1 PC following a period of active surveillance (AS) compared with men undergoing immediate radical prostatectomy (RP) to evaluate what is potentially lost in terms of cancer control, if a patient trials AS and transitions to treatment.
METHODS
We reviewed the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry for men with GG1 PC undergoing RP from April 2012 to July 2018. Men were classified into groups based on time from diagnosis to RP: immediate (surgery within 1 year of diagnosis) and delayed RP (surgery >1 year after initiation of AS). Time to secondary treatment was estimated using Kaplan-Meier curves and compared using the log-rank test. A multivariable Cox proportional hazards model was fit to assess the association between timing of RP and use of secondary treatments. A chi-squared test was used to assess the association between delayed RP and adverse pathology.
RESULTS
We identified 1878 men that underwent an RP during the study period, of which 1489 (79%) underwent immediate RP and 389 (21%) underwent delayed RP. The incidence of adverse pathology was higher in men with delayed versus immediate RP (49% vs. 36%, p < 0.0001, respectively). However, we noted only a small absolute difference in the estimated 24-month secondary treatment-free probability between men with delayed versus immediate RP (93% and 96%, respectively). On multivariable analysis, delayed RP was associated with increased use of secondary treatments (hazard ratio = 1.94, 95% confidence interval = 1.23-3.06, p = 0.004).
CONCLUSIONS
The use of secondary treatment after RP in men with GG1 PC undergoing immediate or delayed prostatectomy was rare. These data suggest that the burden of treatment is near equivalent in patients who progress to treatment on AS compared with those who underwent immediate RP.
背景
我们评估了与立即接受根治性前列腺切除术（RP）的男性相比，在接受主动监测（AS）一段时间后，GG1 前列腺癌患者接受二级治疗的情况，以评估如果患者尝试 AS 并转为治疗，在癌症控制方面可能会失去什么。
方法
我们回顾了密歇根泌尿外科学术改进合作组织（MUSIC）登记处 2012 年 4 月至 2018 年 7 月期间接受 RP 的 GG1 前列腺癌男性的数据。男性根据从诊断到 RP 的时间分为两组：立即（诊断后 1 年内手术）和延迟 RP（AS 开始后 1 年以上手术）。使用 Kaplan-Meier 曲线估计二次治疗时间，并使用对数秩检验进行比较。拟合多变量 Cox 比例风险模型以评估 RP 时机与二级治疗使用之间的关联。使用卡方检验评估延迟 RP 与不良病理之间的关联。
结果
我们确定了 1878 名在研究期间接受 RP 的男性，其中 1489 名（79%）接受了立即 RP，389 名（21%）接受了延迟 RP。与立即 RP 相比，延迟 RP 的男性不良病理发生率更高（分别为 49%和 36%，p<0.0001）。然而，我们注意到，延迟 RP 与立即 RP 之间的 24 个月二级无治疗生存率的绝对差异很小（分别为 93%和 96%）。多变量分析显示，延迟 RP 与二级治疗的使用增加相关（风险比=1.94，95%置信区间=1.23-3.06，p=0.004）。
结论
在接受立即或延迟前列腺切除术的 GG1 前列腺癌患者中，RP 后使用二级治疗的情况很少见。这些数据表明，与立即接受 RP 的患者相比，在 AS 进展为治疗的患者中，治疗负担几乎相同。
Zotero 插件