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Active Surveillance for Intermediate-Risk Prostate Cancer: Systematic Review and Meta-analysis of Current Protocols and Outcomes.
Clinical Genitourinary Cancer ( IF 3.2 ) Pub Date : 2020-05-22 , DOI: 10.1016/j.clgc.2020.05.008
Dmitry Enikeev 1 , Andrey Morozov 1 , Mark Taratkin 1 , Eric Barret 2 , Vasiliy Kozlov 3 , Nirmish Singla 4 , Juan Gomez Rivas 5 , Alexey Podoinitsin 6 , Vitaly Margulis 4 , Petr Glybochko 1
Affiliation  

Introduction

Current guidelines allow active surveillance for intermediate-risk prostate cancer patients but do not provide comprehensive recommendations for selection. We performed a systematic review and meta-analysis of outcomes for active surveillance in intermediate- and low-risk groups.

Methods

We performed a systematic literature search of intermediate-risk localized prostate cancer patients undergoing active surveillance using 3 literature search engines (Medline, Web of Science, and Scopus) over the past 10 years. The primary outcome was the percentage of patients who remain under surveillance. Secondary outcomes included cancer-specific survival, overall survival, and metastasis-free survival. For articles including both low- and intermediate-risk patients undergoing active surveillance, comparisons between the two groups were made.

Results

The proportion of patients who remained on active surveillance was comparable between the low- and intermediate-risk groups after 10 and 15 years’ follow-up (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.83–1.14; and OR, 0.86; 95% CI, 0.65–1.13). Cancer-specific survival was worse in the intermediate-risk group after 10 years (OR, 0.47; 95% CI, 0.31–0.69) and 15 years (OR, 0.34; 95% CI, 0.2–0.58). The overall survival rate showed no statistical difference at 5 years’ follow-up (OR, 0.84; 95% CI, 0.45–1.57) but was worse in the intermediate-risk group after 10 years (OR, 0.43; 95% CI, 0.35–0.53). Metastases-free survival did not significantly differ after 5 years (OR, 0.55; 95% CI, 0.2–1.53) and was worse in the intermediate-risk group after 10 years (OR, 0.46; 95% CI, 0.28–0.77).

Conclusion

Active surveillance could be offered to patients with intermediate-risk prostate cancer. However, they should be informed of the need for regular monitoring and the possibility of discontinuation as a result of a higher rate of progression. Available data indicate that 5-year survival rates between intermediate- and low-risk patients do not differ; 10-year survival rates are worse. To assess the long-term effectiveness and safety of active surveillance, it is necessary to develop unified algorithms for patient selection and management, and to prospectively conduct studies with long-term surveillance.



中文翻译:

中度风险前列腺癌的主动监测:对当前方案和结果的系统回顾和荟萃分析。

介绍

目前的指南允许对中危前列腺癌患者进行主动监测,但没有提供全面的选择建议。我们对中低风险人群的主动监测结果进行了系统回顾和荟萃分析。

方法

在过去 10 年中,我们使用 3 个文献搜索引擎(Medline、Web of Science 和 Scopus)对接受主动监测的中度风险局限性前列腺癌患者进行了系统的文献检索。主要结果是继续接受监测的患者百分比。次要结局包括癌症特异性生存期、总生存期和无转移生存期。对于包括接受主动监测的低风险和中风险患者的文章,对两组进行了比较。

结果

在 10 年和 15 年的随访后,低风险组和中等风险组之间保持主动监测的患者比例相当(优势比 [OR],0.97;95% 置信区间 [CI],0.83–1.14;和 OR,0.86;95% CI,0.65–1.13)。10 年后(OR,0.47;95% CI,0.31-0.69)和 15 年(OR,0.34;95% CI,0.2-0.58)后,中危组的癌症特异性生存率更差。5 年随访时总生存率无统计学差异(OR,0.84;95% CI,0.45-1.57),但 10 年后中危组更差(OR,0.43;95% CI,0.35 –0.53)。5 年后无转移生存率没有显着差异(OR,0.55;95% CI,0.2-1.53​​),10 年后中危组更差(OR,0.46;95% CI,0.28-0.77)。

结论

可以为中危前列腺癌患者提供主动监测。然而,他们应该被告知需要定期监测以及由于更高的进展率而停药的可能性。现有数据表明,中低风险患者的 5 年生存率没有差异;10年生存率更差。为了评估主动监测的长期有效性和安全性,有必要制定统一的患者选择和管理算法,并前瞻性地开展长期监测研究。

更新日期:2020-05-22
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