台灣侷限性攝護腺癌患者接受積極監測之預後及預測模型

查舫宇1、洪健華1、郭名捷^1,2、鄭詠庭³、呂育全⁴、黃昭淵1、陳忠信1、蒲永孝1

國立臺灣大學醫學院附設醫院 1泌尿部，

國立臺灣大學醫學院附設醫院 2雲林分院泌尿部

國立臺灣大學醫學院附設醫院 3竹分院泌尿部

國立臺灣大學醫學院附設醫院癌醫中心分院 4腫瘤外科部

Active Surveillance in Taiwanese Men with Localized Prostate Cancer: Outcomes and Predicting Models

Fang-Yu Cha¹, Jian-Hua Hong,¹ Ming-Chieh Kuo,^1,2 Yung-Ting Cheng,³ Yu-Chuan Lu,⁴ Chao-Yuan Huang,¹ Chung-Hsin Chen,^1,* and Yeong-Shiau Pu¹

¹Department of Urology, National Taiwan University Hospital, Taipei, Taiwan

²Department of Urology, National Taiwan University Hospital Yunlin Branch

³Department of Urology, National Taiwan University Hospital Hsin-Chu Branch

⁴Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan

Abstract

Purpose:

To investigate the intermediate-term outcome of prostate cancer (PC) patients receiving active surveillance (AS).

Materials and Methods:

This prospective cohort study enrolled Asian men with localized non-high-risk PC diagnosed between June 2012 and April 2021. The study endpoints were reclassification (either pathological or radiographic) and conversion to active treatments. Factors predicting these endpoints were evaluated using the Cox proportional hazards model.

Results:

A consecutive of 313 patients (median 66.9 years of age) were enrolled and followed-up with a median of 61.3 months (IQR 38.9-82.1). Based on the NCCN risk grouping, 67 (21.4%), 122 (39.0%), 100 (32.0%) and 24 (7.7%) men were classified as very low-risk (VLR), low-risk (LR), favorable intermediate-risk (FIR), and unfavorable intermediate-risk (UIR) PC, respectively. The 5-year reclassification rate was 27.9%, 29.5%, 25.8% and 29.2%, respectively (P for trend: 0.949). The 5-year conversion rate was 18.6%, 30.4%, 38.3% and 32.8%, respectively (P for trend: 0.004). PSA density ³ 0.15 ng/mL² independently predicted both reclassification (hazard ratio (HR) 1.72, 95% CI. 1.08-2.75) and conversion (HR 1.85, 95% CI. 1.15-2.95). The maximal percentage of cancer in positive cores (MPCPC) of ³15% also predicted conversion (15% to <50%: HR 1.85, 95% CI. 1.13-3.04; >50%: HR 2.38, 95% CI. 1.29-4.38) compared to <15%. One man developed metastasis but no one died of PC.

Conclusions:

AS is a viable option for Asian men with non-high-risk PC in terms of reclassification and conversion. The higher the risk group, the higher the conversion rate, but not reclassification rate. High PSA density predicted reclassification, while high PSA density and MPCPC predicted conversion.