Impact of compliance on outcomes for patients on active surveillance for prostate cancer.
Notice bibliographique
Résumé
36 Background: Active surveillance (AS) is the standard of care for low-risk prostate cancer to reduce the risk of overtreatment. However, the impact of compliance to AS on outcomes has not been well described. We hypothesized that compliance to an AS protocol and to the recommendation for active treatment would affect subsequent treatment failure. Methods: A prospective, single-arm cohort study was initiated in 1995 to assess an AS program. Triggers for intervention included a PSA doubling time of less than three years and histologic upgrade. The AS protocol was defined as PSA measurements every three months for two years and then twice annually, as well as a confirmatory biopsy within 12 months and then every three years. Compliance to the AS protocol was defined as four PSA tests and a confirmatory biopsy by 1.5 years after enrollment. Compliance to treatment was defined as the initiation of any active therapy within 12 months from the time of any trigger described above. Treatment failure was defined as a PSA > 0.2 after surgery, PSA > nadir + 2 for other treatments, or the development of metastases. Statistics were performed using logistic regression analysis and the Fisher exact test. Results: A total of 1282 patients were included in the final analysis, of which 460 received treatment. Median follow up was 7.1 years. The actuarial rate of biochemical control at five and 10 years amongst treated patients was 78% and 59% respectively. The rates of compliance to biopsy at years one, four and seven were 71%, 36% and 13%. The treatment failure rate was lower for patients compliant to the AS protocol (crude rate 28%) than those non-compliant (crude rate 38%) with an odds ratio of 0.64 (95% CI 0.43-0.94, p = 0.03). Patients compliant to the protocol were also less likely to develop metastases (OR 0.42, 95% CI 0.21-0.88, p = 0.02). There was no impact on treatment failure by adherence to active therapy within 12 months (p = 0.25) after reaching a trigger to come off AS. Conclusions: Non-compliance to an AS protocol leads to a higher risk of subsequent treatment failure and development of metastases. Physicians and patients need to work together diligently to ensure enrollment on an AS program is followed by adherence to regular PSA checks and repeat biopsies.
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 | 0,005 | 0,017 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
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 ».