The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China.
Department of Urology, Taizhou First People's Hospital, Taizhou 318020, China.
Curr Oncol. 2022 Oct 21;29(10):7964-7978. doi: 10.3390/curroncol29100630.
Few studies have focused on the link between active surveillance (AS) and Gleason score upgrade (GSU) and its impact on the prognosis of patients with prostate cancer (PCa). This study aimed to analyze the effect of AS duration on GSU and prognostic value based on risk stratification. All eligible patients were risk-stratified according to AUA guidelines into low-risk (LR), favorable intermediate-risk (FIR), and unfavorable intermediate-risk (UIR) PCa. Within the Surveillance, Epidemiology, and End Results Program (SEER) database, 28,368 LR, 27,243 FIR, and 12,210 UIR PCa patients were included. The relationship between AS duration and GSU was identified with univariate and multivariate logistic regression. Discrimination according to risk stratification of AS duration and GSU was tested by Kaplan-Meier analysis and competing risk regression models. The proportion of patients who chose AS was the highest among LR PCa (3434, 12.1%), while the proportion in UIR PCa was the lowest (887, 7.3%). The AS duration was only associated with GSU in LR PCa, with a high Gleason score (GS) at diagnosis being a strong predictor of GSU for FIR and UIR PCa. Kaplan-Meier analysis indicated that long-term surveillance only made a significant difference in prognosis in UIR PCa. The competing risk analysis indicated that once GS was upgraded to 8 or above, the prognosis in each group was significantly worse. AS is recommended for LR and FIR PCa until GS is upgraded to 8, but AS may not be suitable for some UIR PCa patients.
很少有研究关注主动监测 (AS) 与 Gleason 评分升级 (GSU) 之间的联系及其对前列腺癌 (PCa) 患者预后的影响。本研究旨在分析 AS 持续时间对 GSU 的影响，并根据风险分层分析其预后价值。所有符合条件的患者均根据 AUA 指南分为低危 (LR)、中危有利 (FIR) 和中危不利 (UIR) PCa。在监测、流行病学和最终结果计划 (SEER) 数据库中，纳入了 28368 例 LR、27243 例 FIR 和 12210 例 UIR PCa 患者。采用单因素和多因素逻辑回归分析确定 AS 持续时间与 GSU 之间的关系。通过 Kaplan-Meier 分析和竞争风险回归模型测试 AS 持续时间和 GSU 风险分层的区分能力。在 LR PCa 中，选择 AS 的患者比例最高 (3434，12.1%)，而在 UIR PCa 中比例最低 (887，7.3%)。AS 持续时间仅与 LR PCa 的 GSU 相关，诊断时高 GS 是 FIR 和 UIR PCa 发生 GSU 的强烈预测因素。Kaplan-Meier 分析表明，长期监测仅对 UIR PCa 的预后有显著影响。竞争风险分析表明，一旦 GS 升级到 8 或更高，每组的预后都会显著恶化。建议对 LR 和 FIR PCa 进行 AS，直到 GS 升级到 8，但 AS 可能不适合某些 UIR PCa 患者。
