본문 바로가기
KERD
논문KCI 등재

Selection Criteria for Active Surveillance of Patients with Prostate Cancer in Korea: A Multicenter Analysis of Pathology after Radical Prostatectomy

2

조회

0

다운로드

5

인용

0

참고문헌

키워드

주제분류의학일반

초록

Purpose Korean patients with prostate cancer (PC) typically present with a more aggressive disease than patients in Western populations. Consequently, it is unclear if the current criteria for active surveillance (AS) can safely be applied to Korean patients. Therefore, this study was conducted to define appropriate selection criteria for AS for patients with PC in Korea. Materials and Methods We conducted a multicenter retrospective study of 2,126 patients with low risk PC who actually underwent radical prostatectomy. The primary outcome was an unfavorable disease, which was defined by non-organ confined disease or an upgrading of the Gleason score to ! 7 (4+3). Predictive variables of an unfavorable outcome were identified by multivariate analysis using randomly selected training samples (n=1,623, 76.3%). We compared our selected criteria to various Western criteria for the primary outcome and validated our criteria using the remaining validation sample (n=503, 23.7%). Results A non-organ confined disease rate of 14.9% was identified, with an increase in Gleason score ! 7 (4+3) of 8.7% and a final unfavorable disease status of 20.8%. The following criteria were selected: Gleason score " 6, clinical stage T1-T2a, prostate-specific antigen (PSA) " 10 ng/mL, PSA density < 0.15 ng/mL/mL, number of positive cores " 2, and maximum cancer involvement in any one core " 20%. These criteria provided the lowest unfavorable disease rate (11.7%) when compared to Western criteria (13.3%-20.7%), and their validity was confirmed using the validation sample (5.9%). Conclusion We developed AS criteria which are appropriate for Korean patients with PC. Prospective studies using these criteria are now warranted.

Abstract

Purpose Korean patients with prostate cancer (PC) typically present with a more aggressive disease than patients in Western populations. Consequently, it is unclear if the current criteria for active surveillance (AS) can safely be applied to Korean patients. Therefore, this study was conducted to define appropriate selection criteria for AS for patients with PC in Korea. Materials and Methods We conducted a multicenter retrospective study of 2,126 patients with low risk PC who actually underwent radical prostatectomy. The primary outcome was an unfavorable disease, which was defined by non-organ confined disease or an upgrading of the Gleason score to ! 7 (4+3). Predictive variables of an unfavorable outcome were identified by multivariate analysis using randomly selected training samples (n=1,623, 76.3%). We compared our selected criteria to various Western criteria for the primary outcome and validated our criteria using the remaining validation sample (n=503, 23.7%). Results A non-organ confined disease rate of 14.9% was identified, with an increase in Gleason score ! 7 (4+3) of 8.7% and a final unfavorable disease status of 20.8%. The following criteria were selected: Gleason score " 6, clinical stage T1-T2a, prostate-specific antigen (PSA) " 10 ng/mL, PSA density < 0.15 ng/mL/mL, number of positive cores " 2, and maximum cancer involvement in any one core " 20%. These criteria provided the lowest unfavorable disease rate (11.7%) when compared to Western criteria (13.3%-20.7%), and their validity was confirmed using the validation sample (5.9%). Conclusion We developed AS criteria which are appropriate for Korean patients with PC. Prospective studies using these criteria are now warranted.

참고문헌 (30)

  1. Heidenreich A, "EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intentupdate 2013", Eur Urol, 65, pp.124~137 (2014)[DOI]
  2. Mohler JL, "Prostate cancer, version 2.2014", J Natl Compr Canc Netw., 12, pp.686~718 (2014)[DOI]
  3. Klotz L, "Long-term follow-up of a large active surveillance cohort of patients with prostate cancer", J Clin Oncol, 33, pp.272~277 (2015)
  4. D'Amico AV, "Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer", JAMA, 280, pp.969~974 (1998)[DOI]
  5. 변석수, "Recent Changes in the Clinicopathologic Features of Korean Men with Prostate Cancer: A Comparison with Western Populations", Yonsei Medical Journal, 53(3), pp.543~549 (2012), 연세대학교의과대학[DOI]
  6. Jeong CW, "Nomograms to predict the pathological stage of clinically localized prostate cancer in Korean men: comparison with western predictive tools using decision curve analysis", Int J Urol, 19, pp.846~852 (2012)[DOI]
  7. Kang M, "Pre- and post-operative nomograms to predict recurrence-free probability in korean men with clinically localized prostate cancer", PLoS One, 9, pp.e100053~ (2014)[DOI]
  8. Kim TH, "Pathological upgrading and upstaging of patients eligible for active surveillance according to currently used protocols", Int J Urol, 21, pp.377~381 (2014)[DOI]
  9. Lee DH, "Comparison of pathological outcomes of active surveillance candidates who underwent radical prostatectomy using contemporary protocols at a high-volume Korean center", Jpn J Clin Oncol, 42, pp.1079~1085 (2012)[DOI]
  10. 정문수, "Current status of active surveillance in prostate cancer", Investigative and Clinical Urology, 57(1), pp.14~20 (2016), 대한비뇨의학회[DOI]
  11. Ploussard G, "The contemporary concept of significant versus insignificant prostate cancer", Eur Urol, 60, pp.291~303 (2011)[DOI]
  12. Jeong SJ, "Development and validation of nomograms to predict the recovery of urinary continence after radical prostatectomy: comparisons between immediate, early, and late continence", World J Urol, 32, pp.437~444 (2014)[DOI]
  13. Whitson JM, "The relationship between prostate specific antigen change and biopsy progression in patients on active surveillance for prostate cancer", J Urol, 185, pp.1656~1660 (2011)[DOI]
  14. van den Bergh RC, "Prospective validation of active surveillance in prostate cancer: the PRIAS study", Eur Urol, 52, pp.1560~1563 (2007)[DOI]
  15. Soloway MS, "Careful selection and close monitoring of lowrisk prostate cancer patients on active surveillance minimizes the need for treatment", Eur Urol, 58, pp.831~835 (2010)[DOI]
  16. Carter HB, "Expectant management of prostate cancer with curative intent: an update of the Johns Hopkins experience", J Urol, 178, pp.2359~2364 (2007)[DOI]
  17. Adamy A, "Role of prostate specific antigen and immediate confirmatory biopsy in predicting progression during active surveillance for low risk prostate cancer", J Urol, 185, pp.477~482 (2011)[DOI]
  18. Torre LA, "Global cancer statistics, 2012", CA Cancer J Clin, 65, pp.87~108 (2015)[DOI]
  19. Jeong IG, "Differences in the aggressiveness of prostate cancer among Korean, Caucasian, and African American men: a retrospective cohort study of radical prostatectomy", Urol Oncol, 34, pp.3~ (2016)
  20. Raymundo EM, "Prostate cancer in Asian Americans: incidence, management and outcomes in an equal access healthcare system", BJU Int, 107, pp.1216~1222 (2011)[DOI]
  21. Reese AC, "Expanded criteria to identify men eligible for active surveillance of low risk prostate cancer at Johns Hopkins: a preliminary analysis", J Urol, 190, pp.2033~2038 (2013)[DOI]
  22. Mizuno K, "Evaluation of predictors of unfavorable pathological features in men eligible for active surveillance using radical prostatectomy specimens: a multi-institutional study", Jpn J Clin Oncol, 46, pp.1156~1161 (2016)
  23. Bokhorst LP, "A decade of active surveillance in the PRIAS study: an update and evaluation of the criteria used to recommend a switch to active treatment", Eur Urol, 70, pp.954~960 (2016)[DOI]
  24. Sugimoto M, "Should inclusion criteria for active surveillance for low-risk prostate cancer be more stringent? From an interim analysis of PRIAS-JAPAN", World J Urol, 33, pp.981~987 (2015)[DOI]
  25. Choo SH, "Predictive factors of unfavorable prostate cancer in patients who underwent prostatectomy but eligible for active surveillance", Prostate Int, 2, pp.70~75 (2014)[DOI]
  26. Lim SK, "Yonsei criteria: a new protocol for active surveillance in the era of robotic and local ablative surgeries", Clin Genitourin Cancer, 11, pp.501~507 (2013)[DOI]
  27. Kakehi Y, "Prospective evaluation of selection criteria for active surveillance in Japanese patients with stage T1cN0M0 prostate cancer", Jpn J Clin Oncol, 38, pp.122~128 (2008)[DOI]
  28. Epstein JI, "The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma", Am J Surg Pathol, 29, pp.1228~1242 (2005)[DOI]
  29. Jeong CW, "The role of 3-tesla diffusion-weighted magnetic resonance imaging in selecting prostate cancer patients for active surveillance", Prostate Int, 2, pp.169~175 (2014)[DOI]
  30. Park BH, "Role of multiparametric 3.0-Tesla magnetic resonance imaging in patients with prostate cancer eligible for active surveillance", BJU Int, 113, pp.864~870 (2014)[DOI]

관련 논문AI추천

Recent Changes in the Clinicopathologic Features of Korean Men with Prostate Cancer: A Comparison with Western Populations변석수, 서성일, 송채린, 안한종, 이상은, 이상철, 이은식, 이현무, 조진선, 최영득, 최한용연세대학교의과대학 · Yonsei Medical Journal2012 · 제53권 제3호Is Small Prostate Volume a Predictor of Gleason Score Upgrading after Radical Prostatectomy?이동훈, 이승환, 정문수, 정병하연세대학교의과대학 · Yonsei Medical Journal2013 · 제54권 제4호Re-stratification of Patients with High-Risk Prostate Cancer According to the NCCN Guidelines among Patients Who Underwent Radical Prostatectomy: An Analysis Based on the K-CaP Registry구교철, 김청수, 나군호, 변석수, 이광석, 이지열, 이현무, 정병하, 최인영, 홍성규, 홍준혁대한암학회 · Cancer Research and Treatment2018 · 제50권 제1호한국 전립샘암 데이터베이스를 활용한 근치적 전립샘절제술 후 생화학적 재발 예측김청수, 박용현, 변석수, 서성일, 유성혜, 이선정, 정창욱, 최문주, 최인영, 홍준혁한국보건정보통계학회 · 보건정보통계학회지2019 · 제44권 제1호A Predictive Model Based on Bi-parametric Magnetic Resonance Imaging and Clinical Parameters for Clinically Significant Prostate Cancer in the Korean Population천준, 강석호, 강성구, 강하은, 노태일, 성득제, 심지성, 이정구, 진현정, 태종현, 현창완대한암학회 · Cancer Research and Treatment2021 · 제53권 제4호Clinical Outcomes of Postoperative Radiotherapy Following Radical Prostatectomy in Patients with Localized Prostate Cancer: A Multicenter Retrospective Study (KROG 18-01) of a Korean Population박원, 김영경, 김영석, 김재성, 김준상, 김진호, 남택근, 심수정, 위찬우, 이성욱, 정송미, 조관호, 조원경, 조재호, 최영민대한암학회 · Cancer Research and Treatment2020 · 제52권 제1호

이 간행물의 다른 논문 (29건)