Reverse Stage Shift at a Tertiary Care Center Escalating Risk in Men Undergoing Radical Prostatectomy

被引:51
作者
Silberstein, Jonathan L. [1 ]
Vickers, Andrew J. [2 ]
Power, Nicholas E. [1 ]
Fine, Samson W. [3 ]
Scardino, Peter T. [1 ]
Eastham, James A. [1 ]
Laudone, Vincent P. [1 ]
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Surg, Urol Serv, New York, NY 10065 USA
[2] Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, New York, NY 10065 USA
[3] Mem Sloan Kettering Canc Ctr, Dept Pathol, New York, NY 10065 USA
关键词
prostatic neoplasm; prostate cancer; risk; robotic; prostatectomy; active surveillance; minimally invasive surgery; CONSENSUS CONFERENCE; CANCER; TRENDS; MORTALITY; BIOPSY;
D O I
10.1002/cncr.26132
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUND: The objective of this study was to evaluate changes in clinical and pathologic characteristics of prostate cancer in patients who underwent surgery at a large tertiary care center in the context of increased use of active surveillance (AS) and minimally invasive surgery (MIS). METHODS: The authors retrospectively reviewed 6624 patients with localized prostate cancer who underwent radical prostatectomy from 2000 to 2010 at Memorial Sloan-Kettering Cancer Center. Patients were stratified by surgical approach (open, laparoscopic, or robotic) and by risk category (low, intermediate, or high). Patients with low-risk disease, without intervention, and with a minimum follow-up of 6 months were considered to have elected AS. RESULTS: The number of patients who had AS increased from < 20 per year between 2000 and 2004 to >= 100 per year between 2007 and 2009. Over the same decade, the number of patients who underwent MIS (laparoscopic or robotic) increased from zero to 63% of all surgical cases. The percentage of patients in the intermediate-risk and high-risk categories increased over time, whereas the percentage of patients in the low-risk category decreased (odds ratio [OR] per year, 0.91; 95% confidence interval [CI], 0.89-0.92; P < .0005). The proportion of patients who underwent surgery with Gleason 6 tumors decreased over time (OR per year, 0.87; 95% CI, 0.85-0.88; P < .0005), whereas pathologic stage and Gleason score increased (P <.0005). The proportion of low-risk patients decreased across all types of surgery, and the largest decrease was observed for robotic surgery (P < .0005). CONCLUSIONS: A reverse stage shift was observed in patients who underwent radical prostatectomy after 2000 despite the introduction and rapid proliferation of MIS. This shift may have been caused in part by the increased use of AS and an institutional focus on the treatment of higher risk disease. Cancer 2011; 117: 4855-60. (C) 2011 American Cancer Society.
引用
收藏
页码:4855 / 4860
页数:6
相关论文
共 23 条
[1]   Role of Prostate Specific Antigen and Immediate Confirmatory Biopsy in Predicting Progression During Active Surveillance for Low Risk Prostate Cancer [J].
Adamy, Ari ;
Yee, David S. ;
Matsushita, Kazuhito ;
Maschino, Alexandra ;
Cronin, Angel ;
Vickers, Andrew ;
Guillonneau, Bertrand ;
Scardino, Peter T. ;
Eastham, James A. .
JOURNAL OF UROLOGY, 2011, 185 (02) :477-482
[2]  
[Anonymous], J UROL 2
[3]  
[Anonymous], J UROL 2
[4]   New Technology and Health Care Costs - The Case of Robot-Assisted Surgery [J].
Barbash, Gabriel I. ;
Glied, Sherry A. .
NEW ENGLAND JOURNAL OF MEDICINE, 2010, 363 (08) :701-704
[5]   Pathological Upgrading and Up Staging With Immediate Repeat Biopsy in Patients Eligible for Active Surveillance [J].
Berglund, Ryan K. ;
Masterson, Timothy A. ;
Vora, Kinjal C. ;
Eggener, Scott E. ;
Eastham, James A. ;
Guillonneau, Bertrand D. .
JOURNAL OF UROLOGY, 2008, 180 (05) :1964-1967
[6]  
Brawley OW, 1997, CANCER-AM CANCER SOC, V80, P1857, DOI 10.1002/(SICI)1097-0142(19971101)80:9<1857::AID-CNCR26>3.0.CO
[7]  
2-3
[8]   Contemporary trends in low risk prostate cancer: Risk assessment and treatment [J].
Cooperberg, Matthew R. ;
Broering, Jeannette M. ;
Kantoff, Philip W. ;
Carroll, Peter R. .
JOURNAL OF UROLOGY, 2007, 178 (03) :S14-S19
[9]   Time Trends and Local Variation in Primary Treatment of Localized Prostate Cancer [J].
Cooperberg, Matthew R. ;
Broering, Jeanette M. ;
Carroll, Peter R. .
JOURNAL OF CLINICAL ONCOLOGY, 2010, 28 (07) :1117-1123
[10]  
D'Amico AV, 1998, CANCER, V82, P1887, DOI 10.1002/(SICI)1097-0142(19980515)82:10<1887::AID-CNCR11>3.3.CO