Hong Jian-Hua, Kuo Ming-Chieh, Cheng Yung-Ting, Lu Yu-Chuan, Huang Chao-Yuan, Liu Shih-Ping, Chow Po-Ming, Huang Kuo-How, Chueh Shih-Chieh Jeff, Chen Chung-Hsin, Pu Yeong-Shiau
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Urology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
World J Mens Health. 2024 Jul;42(3):587-599. doi: 10.5534/wjmh.230107. Epub 2023 Sep 26.
Active surveillance (AS) is one of the management options for patients with low-risk and select intermediate-risk prostate cancer (PC). However, factors predicting disease reclassification and conversion to active treatment from a large population of pure Asian cohorts regarding AS are less evaluated. This study investigated the intermediate-term outcomes of patients with localized PC undergoing AS.
This cohort study enrolled consecutive men with localized non-high-risk PC diagnosed in Taiwan between June 2012 and Jan 2023. The study endpoints were disease reclassification (either pathological or radiographic progression) and conversion to active treatment. The factors predicting endpoints were evaluated using the Cox proportional hazards model.
A total of 405 patients (median age: 67.2 years) were consecutively enrolled and followed up with a median of 64.6 months. Based on the National Comprehensive Cancer Network (NCCN) risk grouping, 70 (17.3%), 164 (40.5%), 140 (34.6%), and 31 (7.7%) patients were classified as very low-risk, low-risk, favorable-intermediate risk, and unfavorable intermediate-risk PC, respectively. The 5-year reclassification rates were 24.8%, 27.0%, 18.6%, and 25.3%, respectively. The 5-year conversion rates were 20.4%, 28.8%, 43.6%, and 37.8%, respectively. A prostate-specific antigen density (PSAD) of ≥0.15 ng/mL² predicted reclassification (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.17-2.88) and conversion (HR 1.56, 95% CI 1.05-2.31). A maximal percentage of cancer in positive cores (MPCPC) of ≥15% predicted conversion (15% to <50%: HR 1.41, 95% CI 0.91-2.18; ≥50%: HR 1.97, 95% CI 1.1453-3.40) compared with that of <15%. A Gleason grade group (GGG) of 3 tumor also predicted conversion (HR 2.69, 95% CI 1.06-6.79; GGG 3 vs 1). One patient developed metastasis, but none died of PC during the study period (2,141 person-years).
AS is a viable option for Taiwanese men with non-high-risk PC, in terms of reclassification and conversion. High PSAD predicted reclassification, whereas high PSAD, MPCPC, and GGG predicted conversion.
主动监测（AS）是低风险和部分中风险前列腺癌（PC）患者的管理选择之一。然而，在大量纯亚洲队列中，关于AS预测疾病重新分类和转为积极治疗的因素评估较少。本研究调查了接受AS的局限性PC患者的中期结局。
本队列研究纳入了2012年6月至2023年1月在台湾连续诊断为局限性非高危PC的男性。研究终点为疾病重新分类（病理或影像学进展）和转为积极治疗。使用Cox比例风险模型评估预测终点的因素。
共连续纳入405例患者（中位年龄：67.2岁），中位随访64.6个月。根据美国国立综合癌症网络（NCCN）风险分组，分别有70例（17.3%）、164例（40.5%）、140例（34.6%）和31例（7.7%）患者被分类为极低风险、低风险、有利中风险和不利中风险PC。5年重新分类率分别为24.8%、27.0%、18.6%和25.3%。5年转化率分别为20.4%、28.8%、43.6%和37.8%。前列腺特异性抗原密度（PSAD）≥0.15 ng/mL²预测重新分类（风险比[HR] 1.84，95%置信区间[CI] 1.17 - 2.88）和转化（HR 1.56，95% CI 1.05 - 2.31）。阳性核心中癌的最大百分比（MPCPC）≥15%预测转化（15%至<50%：HR 1.41，95% CI 0.91 - 2.18；≥50%：HR 1.97，95% CI 1.1453 - 3.40），而<15%时则不然。Gleason分级组（GGG）为3级肿瘤也预测转化（HR 2.69，95% CI 1.06 - 6.79；GGG 3级与1级相比）。1例患者发生转移，但在研究期间（2141人年）无患者死于PC。
就重新分类和转化而言，AS是台湾非高危PC男性的可行选择。高PSAD预测重新分类，而高PSAD、MPCPC和GGG预测转化。
