在初级前列腺癌治疗后高风险生化复发的流行病学
Ugo Giovanni Falagario1, Francesco Pellegrino2, Lars Björnebo3
1Department of Molecular Medicine and Surgery (Solna), Karolinska Institute, Stockholm, Sweden; Department of Urology and Kidney Transplantation, University of Foggia, Foggia, Italy.
European urology oncology
|June 22, 2025
概括
在前列腺癌 (PCa) 治疗后,高危生化复发 (HR-BCR) 的定义各不相同. 根据EMBARK标准确定一个高风险群体,但许多患有BCR的人没有发展HR-BCR,这表明需要精确的风险分层.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 在瘤学瘤学.
- 前列腺癌研究 研究前列腺癌研究
背景情况:
- 前列腺癌 (PCa) 治疗后的生化复发 (BCR) 需要准确的风险分层来指导后续管理.
- 现有的高风险BCR (HR-BCR) 定义可能无法统一地捕捉患有前列腺癌特异性死亡率 (PCSM) 风险最高的患者.
研究的目的:
- 为了评估HR-BCR的不同定义,激进前列腺切除术 (RP) 或局部PCa的放射治疗 (RT) 后.
- 评估这些HR-BCR定义与PCSM风险之间的关联.
主要方法:
- 一项基于人口的队列研究,包括17753名在2003年至2021年期间因局部PCa接受RP或RT治疗的男性.
- 对BCR,欧洲泌尿病学协会 (EAU) HR-BCR和EMBARK HR-BCR标准的累积发病率的评估.
- 使用竞争性风险方法对HR-BCR确定的患者进行PCSM的估计.
主要成果:
- 根据定义和治疗方式,HR-BCR的10年发病率有所不同,EAU和RT定义显示出较高的发病率 (10%) 与RP后EMBARK (4%) 相比.
- 符合EMBARK标准的患者的PCSM发生率最高 (30%在RP后,50%在RT后).
- 显著比例的BCR患者 (在RP后高达50%,RT后31%) 不符合HR-BCR标准,并且PCSM较低.
结论:
- 根据使用的定义和接受的治疗 (RP与RT),HR-BCR发生率和相关的PCSM风险有所不同.
- 根据EMBARK标准,确定一个较小,高风险的小组,具有最大的PCSM风险.
- 使用PSA动力学和先进成像来改进BCR定义对于优化风险分层,平衡治疗疗效和避免过度治疗至关重要.
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