Gnanapragasam Vincent J, Keates Alexandra, Lophatananon Artitaya, Thankapannair Vineetha
Department of Surgery, University of Cambridge, Cambridge, UK.
Cambridge Prostate Cancer and Clinical Trials Group, Cambridge, UK.
BJU Int. 2025 May;135(5):851-859. doi: 10.1111/bju.16666. Epub 2025 Jan 29.
To report 5-year outcomes from the STRATified CANcer Surveillance (STRATCANS) programme based on progression risks using National Institute for Health and Clinical Excellence (NICE) Cambridge Prognostic Group (CPG) at diagnosis, prostate specific antigen density and magnetic resonance imaging (MRI) visibility.
Men with CPG1 and CPG2 disease selecting active surveillance (AS) were included into STRATCANS and allocated to one of three increasing follow-up intensities. Outcome measures were: (i) treatment for CPG≥3 progression (main outcome), (ii) any treatment, (iii) conversion to watchful waiting (WW), (iv) patient self-attrition, and (v) mortality.
A total of 297 men (median age 66.0 years) were reviewed. The median (interquartile range, mean) follow-up for men still on AS was 4.9 (2.7-7.6, 5.3) years. In the cohort, 38.0% were CPG2 and 25.0% Grade Group (GG) 2 at AS entry. Overall, 214/297 (72.1%) remained treatment free: 158 (53.1%) were still on AS, 17 (5.7%) died of other causes, and 39 (13.1%) progressed to WW/discharge. Only 10 (3.4%) left AS from anxiety. There were no cancer deaths or metastatic events. In all, 80 men (26.9%) converted to treatment due to biopsy/MRI progression but only 35 (11.7%) of these reached CPG≥3 disease. Treatment for CPG≥3 occurred in 7.6% of CPG1 and 18.5% of CPG2 disease and 9.9% of GG1 and 17.5% of GG2 disease. By STRATCANS tier, treatment for CPG≥3 disease was 4.7% in STRATCANS 1, 12.9% in STRATCANS 2, and 27.4% in STRATCANS 3 (P < 0.001). STRATCANS had an area under the curve (AUC) of 0.74 for predicting CPG≥3 progression out-performing stratification by GG (AUC 0.64), CPG (0.69) and Likert score (0.51) alone or a combination of MRI visibility and GG (0.64). Longitudinal data have allowed further refinement of the STRATCANS schedule.
The STRATCANS 5-year outcomes demonstrate that a simple risk stratified surveillance using a prognostically meaningful endpoint is safe, durable, has low treatment rates, high patient compliance and appropriately tailors monitoring based on risks of progression. A website and implementation toolkit are now available.
报告基于诊断时使用英国国家卫生与临床优化研究所（NICE）剑桥预后分组（CPG）、前列腺特异性抗原密度和磁共振成像（MRI）可见性的进展风险的分层癌症监测（STRATCANS）计划的5年结果。
选择主动监测（AS）的CPG1和CPG2疾病男性纳入STRATCANS，并分配到三种随访强度逐渐增加的组之一。结局指标为：（i）CPG≥3进展的治疗（主要结局），（ii）任何治疗，（iii）转为观察等待（WW），（iv）患者自行退出，以及（v）死亡率。
共纳入297名男性（中位年龄66.0岁）。仍在接受AS的男性的中位（四分位间距，均值）随访时间为4.9（2.7 - 7.6，5.3）年。在该队列中，38.0%在进入AS时为CPG2，25.0%为分级组（GG）2。总体而言，214/297（72.1%）仍未接受治疗：158（53.1%）仍在接受AS，17（5.7%）死于其他原因，39（13.1%）进展为WW/出院。仅10（3.4%）因焦虑离开AS。无癌症死亡或转移事件。共有80名男性（26.9%）因活检/MRI进展转为治疗，但其中仅35（11.7%）达到CPG≥3疾病。CPG≥3的治疗在CPG1疾病中占7.6%，在CPG2疾病中占18.5%，在GG1疾病中占9.9%，在GG2疾病中占17.5%。按STRATCANS分层，CPG≥3疾病的治疗在STRATCANS 1中为4.7%，在STRATCANS 2中为12.9%，在STRATCANS 3中为27.4%（P < 0.001）。STRATCANS预测CPG≥3进展的曲线下面积（AUC）为0.74，优于单独按GG（AUC 0.64）、CPG（0.69）和李克特评分（0.51）或MRI可见性与GG的组合（0.64）进行分层。纵向数据使STRATCANS方案得到进一步优化。
STRATCANS的5年结果表明，使用具有预后意义的终点进行简单的风险分层监测是安全、持久的，治疗率低，患者依从性高，并能根据进展风险适当调整监测。现在有一个网站和实施工具包可用。
