摘要:局限性前列腺癌是临床上最为常见的疾病阶段,规范及优化疾病的诊疗有望提升患者的预后及生活质量。 2022年 7月,美国泌尿外科学会 (American Urological Association,AUA) 联合美国放射肿瘤学会 (American Society for Radiation Oncology,ASTRO) 共同发布了新一版临床局限性前列腺癌诊疗指南,主要包括风险评 估、疾病分期、基于风险的处理、处理原则以及治疗后随访五个方面,本文对其推荐内容、强度和证据等级等进 行归纳,并结合我国前列腺癌诊疗情况加以讨论和分析。
表 1 AUA/ASTRO 临床局限性前列腺癌指南 (2022) 风险评估推荐[3-5]
表 2 临床局限性前列腺癌的风险分层 (2022 版 vs. 2017 版[1,3])
表 3 AUA/ASTRO 临床局限性前列腺癌指南 (2022) 疾病分期推荐[3-5]
表 4 AUA/ASTRO 临床局限性前列腺癌指南 (2022) 基于风险的处理推荐[3-5]
表 5 AUA/ASTRO 临床局限性前列腺癌指南 (2022) 主动监测的原则推荐[3-5]
表 6 AUA/ASTRO 临床局限性前列腺癌指南 (2022) 根治手术的原则推荐[3-5]
表 7 AUA/ASTRO 临床局限性前列腺癌指南 (2022) 放射治疗的原则推荐[3-5]
表 8 AUA/ASTRO 临床局限性前列腺癌指南 (2022) 治疗后随访推荐[3-5]
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高旭.《2022 AUA/ASTRO 临床局限性前列腺癌指南》 要点解析[J]. 泌尿外科杂志(电子版),2022,14(4):24-30. DOI:10.20020/j.CNKI.1674-7410.2022.04.06
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对于泌尿外科医生而言,在前列腺癌的诊疗工 作中,临床局限性前列腺癌的风险评估、诊疗决策 及随访管理占有非常的重要地位。2017 年,美国 泌 尿外科学会 (American Urological Association, AUA) 曾联合美国放射肿瘤学会 (American Society for Radiation Oncology,ASTRO) 及泌尿肿瘤 学会 (Society of Urologic Oncology,CUO) 共同 发布过临床局限性前列腺癌的诊疗指南[1-2] 。时隔 5 年,AUA 再次联合 ASTRO,共同发布了该指南 的 2022 版本[3-5] 。该指南分为风险评估、疾病分期、 基于风险的处理、处理原则以及治疗后随访等五个 部分,以 44 条配有证据等级及推荐强度的建议陈 述的形式,涵盖了局限性前列腺癌临床诊疗决策中 的绝大多数场景。该指南编写小组成立于 2019 年, 通过对大量相关文献进行系统评价等方法,得出指 南最终的建议内容,其中有大量详细解释及荟萃分 析结果的内容,限于篇幅只能以“补充材料”的形 式发布在 AUA 网站[6] 。本文摘录指南中的相关陈 述,并结合我国前列腺癌诊治现状及临床实践加以解读。
1 风险评估
2 疾病分期
3 基于风险的处理
4 处理原则
4.1 主动监测的原则
4.2 根治手术的原则
4.3 放射治疗的原则
5 治疗后随访
6 小结
6 小结
此次 AUA 联合 ASTRO 发布的 2022 版本临床 局限性前列腺癌诊疗指南,较上一版本更贴近临床 应用。在临床应用过程中需注意,指南中部分推荐 性陈述可能与我国临床诊疗场景不符,或其推荐依 据源于西方人临床研究数据,应结合具体实际加以 甄别使用。
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