前列腺癌切除术后长期随访及主动监测的必要性。

IF 2.3 Q3 ONCOLOGY Prostate Cancer Pub Date : 2020-03-10 eCollection Date: 2020-01-01 DOI:10.1155/2020/7196189
Gregory P Swanson, Wencong Chen, Sean Trevathan, Michael Hermans
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引用次数: 8

摘要

背景:只有真正的长期随访才能确定前列腺癌的最终结局。大多数研究的中位随访时间不到10年,然后预测结果长达15年至20年。我们试图追踪患者至少20年。材料与方法。从1988年到1995年,我们随访了754例接受根治性前列腺切除术的前列腺癌患者,中位随访时间为23.9年(幸存者)。我们排除了淋巴结和精囊阳性患者以及另外47例基线前列腺特异性抗原(PSA)不存在的患者。这就留下了581名患者待分析。结果:结合PSA、Gleason评分、前列腺外伸/切缘阳性等因素,将患者划分为低、中、高3个生化衰竭危险组。在进一步的分析中,我们发现前两组的转移性疾病风险几乎相同(分别为4%和5%),而高危组的转移性疾病风险为19%。高危患者为PSA >20 ng/ml和/或Gleason >7,或Gleason 7 + PSA 10-20 + epe(和/或边缘)阳性。他们有22%的前列腺癌死亡率。结论:在前列腺癌切除术后真正长期随访的患者中,转移性疾病和癌症死亡的风险非常低。风险较低的患者在10年无生化复发后的常规随访中似乎没有获益。由于后期衰竭的风险较高,我们建议高危患者至少再间歇性随访5年(至15年)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Long-Term Follow-Up after Prostatectomy for Prostate Cancer and the Need for Active Monitoring.

Background: Only truly long-term follow-up can determine the ultimate outcome in prostate cancer. Most studies have a median follow-up of less than 10 years and then project outcomes out to 15 and 20 years. We sought to follow patients for at least 20 years. Materials and Methods. We followed 754 prostate cancer patients treated with radical prostatectomy from 1988 to 1995 for a median follow-up (in survivors) of 23.9 years. We excluded lymph node and seminal vesicle positive patients and an additional 47 patients that did not have baseline prostate-specific antigen (PSA). This left 581 patients for analysis.

Results: With the factors of PSA, Gleason score, and extraprostatic extension/margin positivity, we could partition patients into three risk groups for biochemical failure (low, intermediate, and high). In further analysis, we found that the risk of metastatic disease in the first two groups was almost identical (4% and 5%, respectively), while it was 19% in the high-risk group. High-risk patients were those with PSA >20 ng/ml and/or Gleason >7, or Gleason 7 + PSA 10-20 + epe (and or margin) positive. They had a 22% prostate cancer mortality.

Conclusion: In patients with truly long-term follow-up after prostatectomy for prostate cancer, the risk of metastatic disease and cancer death is very low. Patients with the lower risk findings do not appear to benefit from routine follow-up after 10 years free of biochemical recurrence. With a higher risk of later failure, we recommend that the higher risk patients be followed at least intermittently for another 5 years (out to 15 years).

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来源期刊
Prostate Cancer
Prostate Cancer ONCOLOGY-
CiteScore
2.70
自引率
0.00%
发文量
9
审稿时长
13 weeks
期刊介绍: Prostate Cancer is a peer-reviewed, Open Access journal that provides a multidisciplinary platform for scientists, surgeons, oncologists and clinicians working on prostate cancer. The journal publishes original research articles, review articles, and clinical studies related to the diagnosis, surgery, radiotherapy, drug discovery and medical management of the disease.
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