MP42-01 NO SIGNIFICANT IMPROVEMENT IN PATIENT OUTCOMES WHEN STRICTER ACTIVE SURVEILLANCE CRITERIA ARE APPLIED: A COMPARISON OF CONTEMPORARY ACTIVE SURVEILLANCE PROTOCOLS
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Résumé
You have accessJournal of UrologyProstate Cancer: Localized I1 Apr 2015MP42-01 NO SIGNIFICANT IMPROVEMENT IN PATIENT OUTCOMES WHEN STRICTER ACTIVE SURVEILLANCE CRITERIA ARE APPLIED: A COMPARISON OF CONTEMPORARY ACTIVE SURVEILLANCE PROTOCOLS Maria Komisarenko, Narhari Timilshina, Shabbir Alibhai, Neil Fleshner, Alexandre Zlotta, Robert Hamilton, Girish Kulkarni, and Antonio Finelli Maria KomisarenkoMaria Komisarenko More articles by this author , Narhari TimilshinaNarhari Timilshina More articles by this author , Shabbir AlibhaiShabbir Alibhai More articles by this author , Neil FleshnerNeil Fleshner More articles by this author , Alexandre ZlottaAlexandre Zlotta More articles by this author , Robert HamiltonRobert Hamilton More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , and Antonio FinelliAntonio Finelli More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1586AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) is of growing interest as an alternative to radical treatment of low-risk prostate cancer (PCa). However various surveillance eligibility criteria and protocols exist with no consensus among stakeholders as to which criteria and protocol yield the best results for the most patients. Our aim is to discern between the outcomes of stricter versus more inclusive AS protocols and elucidate whether one provides more favorable outcomes for most patients. METHODS Between 1998-2014, 912 men enrolled in an AS program at Princess Margaret Cancer Centre (PM) between, with the following inclusion criteria: PSA ≤10, clinical stage ≤ cT2, Gleason sum ≤ 6, number of positive cores ≤ 3, no single core >50% involved, age ≤ 75 years. All patients who met the set criteria were retrospectively reviewed and assessed for entry eligibility into: Prostate Cancer Research International: Active Surveillance (PRIAS), John Hopkins Medical Institute (JH), University of Miami (UM), University of California, San Francisco (UCSF), Memorial Sloan-Kettering Cancer Center (MSK) and University of Toronto (UT). We also considered how the use of the various protocols would alter the timing and utilization of curative intervention. Univariate and multivariate statistics with Cox proportional hazards were used for comparisons. Logistic regression was used to determine any significant associations. All statistical analysis was done using SAS®. RESULTS From 912 men enrolled over the 16 year period, 712 met PM inclusion criteria. When JH, PRIAS, and UM criteria were applied to these patients 13.7%, 11.5%, and 8.8% of these men were excluded from AS. However, when we compared outcomes such as grade or volume progression there were no significant differences between men who met the PM criteria and those who met stricter AS criteria. No significant differences in PSA velocity, or the number of patient who proceeded to seek treatment (p>0.1). Time to treatment and follow-up were also not significantly different between men who were followed on a more inclusive versus more exclusive AS protocols. CONCLUSIONS While there are differences in inclusion criteria for AS, our results demonstrate that more strict criteria do not significantly improve patient outcomes when considering relative risk of Gleason Score upgrading, or biochemical failure after treatment. In an era of heightened awareness regarding over-diagnosis and overtreatment of prostate cancer, we believe that these stricter entry criteria should be reconsidered. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e508 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Komisarenko More articles by this author Narhari Timilshina More articles by this author Shabbir Alibhai More articles by this author Neil Fleshner More articles by this author Alexandre Zlotta More articles by this author Robert Hamilton More articles by this author Girish Kulkarni More articles by this author Antonio Finelli More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».