■我们在此报告在每日常规环境下接受主动监测(AS)治疗的中危前列腺癌(PCa)患者的长期结局。
■HAROW(2008-2013)是非干预性的,卫生服务研究调查社区环境中本地化PCa的管理。很大比例的研究中心是办公室泌尿科医师。对所有中危AS患者进行随访检查。总的来说,癌症特异性,无转移,和无治疗生存率,以及停药的原因,确定和讨论。
■在2957名患者中,52例中危PCa患者接受AS治疗,可用于评估。中位随访时间为6.8年(四分位距,3.4-8.6年)。7名患者(13.5%)死于与PCa无关的原因,其中4人在AS下或在警惕下等待。2例(3.8%)发生转移。估计总体8年,癌症特异性,无转移,无治疗生存率为85%(95%置信区间[CI],72%-96%),100%,93%(95%CI,82%-100%),和31%(95%CI,17%-45%),分别。在多变量分析中,前列腺特异性抗原密度≥0.2ng/mL2可显著预测接受侵入性治疗(风险比,3.29;p=0.006)。停药的原因通常是由于患者或医生的担忧(36%),而不是由于观察到的临床进展。
尽管在现实生活中的医疗保健条件下接受AS治疗的中危患者的生存结果数据是有希望的,停药率很高,停药通常是病人的决定,即使没有疾病进展的迹象。这可能表明,在这个特定的亚组患者中,精神负担和焦虑水平更高,在做出治疗决定时应该考虑这一点。从心理学的角度来看,并非所有中危患者都是AS的最佳候选者.
UNASSIGNED: We report here the long-term outcomes of patients with intermediate-risk prostate cancer (PCa) treated with active surveillance (AS) in a daily routine setting.
UNASSIGNED: HAROW (2008-2013) was a noninterventional, health service research
study investigating the management of localized PCa in a community setting. A substantial proportion of the
study centers were office-based urologists. A follow-up examination of all intermediate-risk patients with AS was conducted. Overall, cancer-specific, metastasis-free, and treatment-free survival rates, as well as reasons for discontinuation, were determined and discussed.
UNASSIGNED: Of the 2957 patients enrolled, 52 with intermediate-risk PCa were managed with AS and were available for evaluation. The median follow-up was 6.8 years (interquartile range, 3.4-8.6 years). Seven patients (13.5%) died of causes unrelated to PCa, of whom 4 were under AS or under watchful waiting. Two patients (3.8%) developed metastasis. The estimated 8-year overall, cancer-specific, metastasis-free, and treatment-free survival rates were 85% (95% confidence interval [CI], 72%-96%), 100%, 93% (95% CI, 82%-100%), and 31% (95% CI, 17%-45%), respectively. On multivariable analysis, prostate-specific antigen density of ≥0.2 ng/mL2 was significantly predictive of receiving invasive treatment (hazard ratio, 3.29; p = 0.006). Reasons for discontinuation were more often due to patient\'s or physician\'s concerns (36%) than due to observed clinical progression.
UNASSIGNED: Although survival outcome data for intermediate-risk patients managed with AS in real-life health care conditions were promising, rates of discontinuation were high, and discontinuation was often a patient\'s decision, even when the signs of disease progression were absent. This might be an indication of higher levels of mental burden and anxiety in this specific subgroup of patients, which should be considered when making treatment decisions. From a psychological perspective, not all intermediate-risk patients are optimal candidates for AS.