Predicting Active Surveillance Failure for Patients with Prostate Cancer in the Magnetic Resonance Imaging Era: A Multicentre Transatlantic Cohort Study.
코호트
1/5 보강
PICO 자동 추출 (휴리스틱, conf 2/4)
유사 논문P · Population 대상 환자/모집단
719 patients with median follow-up of 5.
I · Intervention 중재 / 시술
추출되지 않음
C · Comparison 대조 / 비교
추출되지 않음
O · Outcome 결과 / 결론
[CONCLUSIONS AND CLINICAL IMPLICATIONS] Contemporary MRI-based AS for PC is safe for suitable patients, including men with noncribriform GG 2 tumours, particularly those that are MRI-invisible. Conversely, patients with cribriform GG 2 disease are at higher risk of AS failure, so consideration of upfront treatment is warranted for this subgroup.
[BACKGROUND AND OBJECTIVE] Magnetic resonance imaging (MRI)-driven active surveillance (AS) is increasingly used for management of prostate cancer (PC).
- p-value p < 0.001
- p-value p = 0.009
- 95% CI 1.5-16.5
- 연구 설계 cohort study
APA
Sushentsev N, Li IG, et al. (2025). Predicting Active Surveillance Failure for Patients with Prostate Cancer in the Magnetic Resonance Imaging Era: A Multicentre Transatlantic Cohort Study.. European urology oncology. https://doi.org/10.1016/j.euo.2025.06.012
MLA
Sushentsev N, et al.. "Predicting Active Surveillance Failure for Patients with Prostate Cancer in the Magnetic Resonance Imaging Era: A Multicentre Transatlantic Cohort Study.." European urology oncology, 2025.
PMID
40645823
Abstract
[BACKGROUND AND OBJECTIVE] Magnetic resonance imaging (MRI)-driven active surveillance (AS) is increasingly used for management of prostate cancer (PC). The aim of our study was to determine the oncological safety of contemporary MRI-driven AS and identify patients at higher risk of AS failure.
[METHODS] This retrospective cohort study included AS patients with MRI-localised PC from three US and UK centres. The primary outcome was AS failure, which was defined as a composite of PC-specific mortality, metastasis, progression to grade group (GG) ≥4, or post-treatment biochemical recurrence. The secondary outcome was disease progression, defined as histological progression to GG 3 or progression to locally advanced disease. Hazard ratios (HRs) were estimated using multivariable Cox models, and multiplicity-adjusted log-rank tests were applied to compare event-free survival across subgroups.
[KEY FINDINGS AND LIMITATIONS] The study cohort comprised 719 patients with median follow-up of 5.2 yr. Of these patients, 629 (87%) had stable disease; 36 (5%) experienced AS failure, including eight (1%) cases of metastasis and no PC-related deaths; and 54 (8%) had disease progression. Cribriform GG 2 histology was the strongest predictor of AS failure (HR 12.7, 95% confidence interval [CI] 4.8-33.6; p < 0.001), followed by tumour MRI visibility (HR 5.0, 95% CI 1.5-16.5; p = 0.009) and noncribriform GG 2 histology (HR 3.4, 95% CI 1.6-7.0; p = 0.001). Event-free survival was comparable for MRI-invisible noncribriform GG 2 and all GG 1 tumours (adjusted p > 0.05 for both outcomes). The study is limited by its retrospective design.
[CONCLUSIONS AND CLINICAL IMPLICATIONS] Contemporary MRI-based AS for PC is safe for suitable patients, including men with noncribriform GG 2 tumours, particularly those that are MRI-invisible. Conversely, patients with cribriform GG 2 disease are at higher risk of AS failure, so consideration of upfront treatment is warranted for this subgroup.
[METHODS] This retrospective cohort study included AS patients with MRI-localised PC from three US and UK centres. The primary outcome was AS failure, which was defined as a composite of PC-specific mortality, metastasis, progression to grade group (GG) ≥4, or post-treatment biochemical recurrence. The secondary outcome was disease progression, defined as histological progression to GG 3 or progression to locally advanced disease. Hazard ratios (HRs) were estimated using multivariable Cox models, and multiplicity-adjusted log-rank tests were applied to compare event-free survival across subgroups.
[KEY FINDINGS AND LIMITATIONS] The study cohort comprised 719 patients with median follow-up of 5.2 yr. Of these patients, 629 (87%) had stable disease; 36 (5%) experienced AS failure, including eight (1%) cases of metastasis and no PC-related deaths; and 54 (8%) had disease progression. Cribriform GG 2 histology was the strongest predictor of AS failure (HR 12.7, 95% confidence interval [CI] 4.8-33.6; p < 0.001), followed by tumour MRI visibility (HR 5.0, 95% CI 1.5-16.5; p = 0.009) and noncribriform GG 2 histology (HR 3.4, 95% CI 1.6-7.0; p = 0.001). Event-free survival was comparable for MRI-invisible noncribriform GG 2 and all GG 1 tumours (adjusted p > 0.05 for both outcomes). The study is limited by its retrospective design.
[CONCLUSIONS AND CLINICAL IMPLICATIONS] Contemporary MRI-based AS for PC is safe for suitable patients, including men with noncribriform GG 2 tumours, particularly those that are MRI-invisible. Conversely, patients with cribriform GG 2 disease are at higher risk of AS failure, so consideration of upfront treatment is warranted for this subgroup.
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