Cancer - Prostate(구연) (E-127)

전향적 코호트를 이용한 한국인 전립선암에서 적극적인 감시를 위한 엄격한 기준 적용의 임상영향 평가
1. 입원의학센터, 서울대학교병원
2. 비뇨의학과, 서울대학교병원
3. 비뇨의학과, 삼성의료원
4. 비뇨의학과, 고려대학교안산병원
5. 비뇨의학교실, 서울대학교 의과대학
서준교1,2, 육형동2, 강민용3, 태범식4, 구자현2,5, 김현회2,5, 곽철 2,5, 정창욱 2,5
Purpose: To evaluate the clinical impact of strict selection criteria for active surveillance (AS) of prostate cancer in a Korean population
Materials and Methods: A single-center, prospectively collected AS cohort from December 2016 to February 2019 (NCT02971085) was used. Following pre-determined criteria, patients were categorized into “strict AS” and “non-strict AS” groups. Clinicopathological progression-free survival (PFS) and treatment-free survival (TFS) of the two groups were compared using the Kaplan–Meier curve and log-rank test. Age-adjusted hazard ratios for clinicopathological progression was calculated using Cox proportional regression analysis.
Results: Of 54 eligible patients, 25 and 29 were assigned to “strict AS” and “non-strict AS,” respectively. The mean age was 66.9±5.2 and 65.5±7.8 years; PSA level was 4.8±1.7 and 6.0±2.2 ng/ml for “strict AS” and “non-strict AS” groups, respectively. Clinicopathological progression and definitive treatment rates were 28.0% (7/25 patients) vs. 58.6% (17/29 patients) and 32.0% (8/25 patients) vs. 62.1% (18/29 patients) in “strict AS” and “non-strict AS” groups. Surgical pathology in the patients who underwent radical prostatectomy was not statistically different between the groups. PFS (mean 34.6±2.9 vs. 22.6±2.7 months, p-value=0.025) and TFS (mean 31.8±3.2 vs. 19.6±2.4 months, p-value=0.018) favor the “strict AS” group than “non-strict AS” group. Age-adjusted hazard ratio for clinicopathological progression of strict criteria was 0.36 (95% confidence interval: 0.14–0.94, p-value=0.04).
Conclusion: PF and TFS were better in the “strict AS” group than in the “non-strict AS” group. This finding should be informed to relevant patients during decision making and considered in Korean guidelines.
keywords : Prostate cancer , Active surveillance, Patient selection