Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
J Urol. 2022 Aug;208(2):325-332. doi: 10.1097/JU.0000000000002668. Epub 2022 Apr 4.
The impact of germline mutations associated with hereditary cancer syndromes in patients on active surveillance (AS) for prostate cancer is poorly defined. We examined the association between family history of prostate cancer (FHP) or family history of cancer (FHC) and risk of progression or adverse pathology at radical prostatectomy (RP) in patients on AS.
Patients on AS at a single tertiary-care center between 2000-2019 were categorized by family history. Disease progression was defined as an increase in Gleason grade on biopsy. Adverse pathology was defined as upgrading/upstaging at RP. Multivariable Cox and logistic regression models were used to assess association between family history and time to progression or adverse pathology, respectively.
Among 3,211 evaluable patients, 669 (21%) had FHP, 34 (1%) had FHC and 95 (3%) had both; 753 progressed on AS and 481 underwent RP. FHP was associated with increased risk of progression (HR 1.31; 95% CI, 1.11-1.55; p=0.002) but FHC (HR 0.67; 95% CI, 0.30-1.50; p=0.3) or family history of both (HR 1.22; 95% CI, 0.81-1.85; p=0.3) were not. FHP, FHC or both were not associated with adverse pathology at RP (p >0.4).
While FHP was associated with an increased risk of progression on AS, wide confidence intervals render this outcome of unclear clinical significance. FHC was not associated with risk of progression on AS. In the absence of known genetically defined hereditary cancer syndrome, we suggest FHP and/or FHC should not be used as a sole trigger to preclude patients from enrolling on AS.
与遗传性癌症综合征相关的种系突变对接受前列腺癌主动监测 (AS) 的患者的影响尚不清楚。我们研究了家族前列腺癌史 (FHP) 或家族癌症史 (FHC) 与接受 AS 的患者行根治性前列腺切除术 (RP) 时进展或不良病理之间的关系。
在 2000 年至 2019 年期间，在一家三级保健中心接受 AS 的患者根据家族史进行分类。疾病进展定义为活检时 Gleason 分级增加。不良病理学定义为 RP 时升级/升级。多变量 Cox 和逻辑回归模型分别用于评估家族史与进展时间或不良病理学之间的关联。
在 3211 例可评估患者中，669 例（21%）有 FHP，34 例（1%）有 FHC，95 例（3%）有两者；753 例在 AS 中进展，481 例行 RP。FHP 与进展风险增加相关（HR 1.31；95%CI，1.11-1.55；p=0.002），但 FHC（HR 0.67；95%CI，0.30-1.50；p=0.3）或两者均无家族史（HR 1.22；95%CI，0.81-1.85；p=0.3）。FHP、FHC 或两者均与 RP 时的不良病理学无关（p>0.4）。
虽然 FHP 与 AS 时的进展风险增加相关，但广泛的置信区间使得该结果的临床意义尚不清楚。FHC 与 AS 时的进展风险无关。在没有已知的遗传性癌症综合征的情况下，我们建议不应仅将 FHP 和/或 FHC 作为排除患者参加 AS 的唯一触发因素。
