Background: The STRATified CANcer Surveillance (STRATCANS) model risk-stratifies patients with prostate cancer (PC) on active surveillance (AS) into three tiers based on their risk of disease progression. We applied STRATCANS to the Michigan Urological Surgery Improvement Collaborative (MUSIC) Prostate registry to assess its association with the risk of biopsy upgrading and time to definitive treatment in a diverse, real-world AS cohort. Methods: We retrospectively reviewed the MUSIC registry for PC patients on AS from 2016 to 2022 and classified patients by STRATCANS tier. Primary outcomes included biopsy upgrading to ≥Grade Group 3 (≥GG3), any biopsy upgrading, and time to definitive treatment. Results: Among 7578 men on AS, 4009, 2732, and 837 patients were in STRATCANS 1, 2, and 3, respectively. The risk of progression to ≥GG3 was 13%, 33%, and 53% for patients in STRATCANS 1, 2, and 3, respectively (p< 0.001). The rate of any biopsy upgrading was approximately 50% at 3 years across all STRATCANS tiers. STRATCANS tiers were also significantly associated with time to definitive treatment, with 16%, 28%, and 35% of men in STRATCANS 1, 2, and 3, respectively, receiving definitive treatment by 36 months. Limitations include confounding inherent to retrospective registry studies, a short 60-month follow-up period, and variability in biopsy method with no centralized pathology and radiology review. Conclusions: STRATCANS has a stepwise association with the risk of progression to ≥GG3 disease and time to definitive treatment among men on AS in the MUSIC cohort, supporting its use as a risk-based, follow-up approach in men on AS.
背景：STRATified CANcer Surveillance（STRATCANS）模型根据疾病进展风险，将接受主动监测（AS）的前列腺癌（PC）患者分为三个风险层级。本研究将STRATCANS模型应用于密歇根泌尿外科手术改进协作组（MUSIC）前列腺癌登记库，旨在评估该模型在一个多样化、真实世界的AS队列中与活检升级风险及至确定性治疗时间的关联性。方法：我们回顾性分析了2016年至2022年间MUSIC登记库中接受AS的PC患者，并依据STRATCANS层级对患者进行分类。主要结局指标包括活检升级至≥分级分组3（≥GG3）、任何级别的活检升级以及至确定性治疗的时间。结果：在7578名接受AS的男性患者中，分别有4009名、2732名和837名患者属于STRATCANS 1、2和3级。STRATCANS 1、2、3级患者进展至≥GG3的风险分别为13%、33%和53%（p<0.001）。所有STRATCANS层级患者在3年时发生任何级别活检升级的比例均约为50%。STRATCANS层级也与至确定性治疗的时间显著相关，在36个月时，STRATCANS 1、2、3级患者中分别有16%、28%和35%接受了确定性治疗。本研究的局限性包括回顾性登记研究固有的混杂因素、较短的60个月随访期，以及活检方法存在差异且缺乏集中的病理学和放射学复核。结论：在MUSIC队列的AS患者中，STRATCANS层级与进展至≥GG3疾病的风险及至确定性治疗的时间存在递进式关联，这支持了其作为一种基于风险的随访策略在AS患者中的应用。
肿瘤(癌症)患者之家