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[大学生论坛]:[大学生论坛]:[大学生论坛]:Comparative Analysis of Biopsy Upgrading in Four Prostate Cancer Active Surveillance Cohorts

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小慧 发表于 2017-12-30 17:01:03 | 显示全部楼层 |阅读模式
Comparative Analysis of Biopsy Upgrading in Four Prostate Cancer Active Surveillance Cohorts


Abstract
摘要
Background:
Active surveillance (AS) is increasingly accepted for managing low-risk prostate cancer, yet there is no consensus about implementation. This lack of consensus is due in part to uncertainty about risks for disease progression, which have not been systematically compared or integrated across AS studies with variable surveillance protocols and dropout to active treatment.
背景:
积极监测(AS)越来越被接受用于管理低风险的前列腺癌,但尚未就实施达成共识。 这种共识的缺乏部分是由于疾病进展风险的不确定性,尚未系统地比较或整合AS研究与变量监测协议和放弃积极治疗。
Objective:
To compare risks for upgrading from a Gleason score (GS) of 6 or less to 7 or more across AS studies after accounting for differences in surveillance intervals and competing treatments and to evaluate tradeoffs of more versus less frequent biopsies.
目的:
在比较监测间隔和竞争性治疗的差异后,通过AS比较Gleason评分(GS)从6或更低的升级至7或更高的风险,并评估更多与不太频繁活检的权衡。
Design:
Joint statistical model of longitudinal prostate-specific antigen (PSA) levels and risks for biopsy upgrading.
实验设计:
纵向前列腺特异性抗原(PSA)水平和活检升级风险的联合统计模型。
Setting:
Johns Hopkins University (JHU); Canary Prostate Active Surveillance Study (PASS); University of California, San Francisco (UCSF); and University of Toronto (UT) AS studies.
设置:
约翰霍普金斯大学(JHU); 金丝雀前列腺主动监测研究(PASS); 加州大学旧金山分校(UCSF); 和多伦多大学(UT)的AS研究。
Patients:
2576 men aged 40 to 80 years with a GS between 2 and 6 and clinical stage T1 or T2 prostate cancer enrolled between 1995 and 2014.
患者:
年龄在40到80岁之间,GS在2-6之间的2576名男性以及在1995年到2014年之间就诊的T1或T2期前列腺癌患者。
Measurements:
PSA levels and biopsy GSs.
测量:
PSA水平和活检GSs。
Results:
After variable surveillance intervals and competing treatments were accounted for, estimated risks for biopsy upgrading were similar in the PASS and UT studies but higher in UCSF and lower in JHU studies. All cohorts had a delay of 3 to 5 months in detecting upgrading with biennial biopsies starting after a first confirmatory biopsy versus annual biopsies.
结果:经过变量监测间隔和竞争性治疗后,活检升级的估计风险在PASS和UT研究中是相似的,但在UCSF中更高,JHU研究中更低。在第一次确认活检与年活检之后,所有组都有3 - 5个月的延迟才开始进行双年活检。
Limitation:
The model does not account for possible misclassification of biopsy GS.
限制:
该模型不考虑对活组织检查可能存在的错误分类。
Conclusion:
Men in different AS studies have different risks for biopsy upgrading after variable surveillance protocols and competing treatments are accounted for. Despite these differences, the consequences of more versus less frequent biopsies seem to be similar across cohorts. Biennial biopsies seem to be an acceptable alternative to annual biopsies.
结论:
不同AS研究中的男性在进行可变监测方案和竞争性治疗后,活检升级的风险不同。 尽管存在这些差异,但更多与不太频繁的活组织检查结果似乎在整个队列中相似。 两年一次的活检似乎是年度活检的可接受替代方法。
Primary Funding Source:
National Cancer Institute.
主要资金来源:
国家癌症研究所。


来源:http://annals.org/aim/article-abstract/2664573/comparative-analysis-biopsy-upgrading-four-prostate-cancer-active-surveillance-cohorts
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