Mukherjee Subhabrata, Papadopoulos Dimitrios, Norris Joseph M, Wani Mudassir, Madaan Sanjeev
Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Rd, London W6 8RF, UK.
Department of Urology, West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation, Twickenham Rd, Isleworth TW7 6AF, UK.
J Clin Med. 2023 Apr 6;12(7):2732. doi: 10.3390/jcm12072732.
Currently, there is no clear consensus regarding the role of active surveillance (AS) in the management of intermediate-risk prostate cancer (IRPC) patients. We aim to analyse data from the available literature on the outcomes of AS in the management of IRPC patients and compare them with low-risk prostate cancer (LRPC) patients. A comprehensive literature search was performed, and relevant data were extracted. Our primary outcome was treatment-free survival, and secondary outcomes were metastasis-free survival, cancer-specific survival, and overall survival. The DerSimonian-Laird random-effects method was used for the meta-analysis. Out of 712 studies identified following an initial search, 25 studies were included in the systematic review. We found that both IRPC and LRPC patients had nearly similar 5, 10, and 15 year treatment-free survival rate, 5 and 10 year metastasis-free survival rate, and 5 year overall survival rate. However, cancer-specific survival rates at 5, 10, and 15 years were significantly lower in IRPC compared to LRPC group. Furthermore, IRPC patients had significantly inferior long-term overall survival rate (10 and 15 year) and metastasis-free survival rate (15 year) compared to LRPC patients. Both the clinicians and the patients can consider this information during the informed decision-making process before choosing AS.
目前，关于主动监测（AS）在中危前列腺癌（IRPC）患者管理中的作用，尚无明确的共识。我们旨在分析现有文献中关于AS在IRPC患者管理中的结果数据，并将其与低危前列腺癌（LRPC）患者的数据进行比较。进行了全面的文献检索，并提取了相关数据。我们的主要结局是无治疗生存期，次要结局是无转移生存期、癌症特异性生存期和总生存期。采用DerSimonian-Laird随机效应方法进行荟萃分析。在初步检索后确定的712项研究中，有25项研究纳入了系统评价。我们发现，IRPC和LRPC患者的5年、10年和15年无治疗生存率、5年和10年无转移生存率以及5年总生存率几乎相似。然而，与LRPC组相比，IRPC患者5年、10年和15年的癌症特异性生存率显著较低。此外，与LRPC患者相比，IRPC患者的长期总生存率（10年和15年）和无转移生存率（15年）明显较差。临床医生和患者在选择AS之前的知情决策过程中都可以考虑这些信息。
