Growing evidence suggests that AS appears oncologically safe in well-selected patients, and magnetic resonance imaging will play a key role in the appropriate selection and follow-up of patients.
Abstract
Objective
Active surveillance (AS) is the preferred management for individuals with low-risk prostate cancer (PCa), but its role in intermediate-risk (IR) disease remains underreported. Given growing interest and published data, we performed an updated systematic review and meta-analysis to evaluate AS outcomes in selected patients with Gleason Grade Group (GG) 1-2 IR PCa.
Methods
A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD420251138532). PubMed/MEDLINE, Embase, and Web of Science databases were searched for studies published up to September 2025 reporting outcomes of AS in IR PCa. Primary outcomes were AS discontinuation-free survival and GG ≥3 upgrade-free survival.
Results
In total, 18 studies, including 3783 selected patients with IR PCa, were analyzed. Pooled AS discontinuation-free survival rates were 70% (95% confidence interval [CI] 62-78) at 3 years, 63% (95% CI 58-68) at 5 years, and 53% (95% CI 38-67) at 10 years. In analyses restricted to GG 2 cohorts, corresponding pooled estimates were 72% at 3 years, 56% at 5 years, and 40% at 10 years. GG ≥3 upgrade-free survival was 84% (95% CI 76-92) at 3 years and 78% (95% CI 65-91) at 5 years in all cohorts and 92% (95% CI 86-98) and 87% (95% CI 78-95) at 3 and 5 years in cohorts screened using multiparametric magnetic resonance imaging. No significant difference in AS discontinuation was observed between biopsy GG 1 and 2 (hazard ratio 1.08; 95% CI 0.86-1.35). Limitations include moderate risk of bias and heterogeneity across AS protocols.
Conclusions
Although long-term data are lacking, particularly regarding robust oncological outcomes, growing evidence suggests that AS appears oncologically safe in well-selected patients. Magnetic resonance imaging will play a key role in the appropriate selection and follow-up of patients.
Background Endoscopic resection (ER) is increasingly used for superficial esophageal cancer (SEC), but pathological examination may reveal features associated with lymph-node metastasis or recurrence. The optimal management of patients with pathologically high-risk SEC remains uncertain because high-quality randomized evidence is lacking and direct comparisons among the available treatment strategies remain limited. Methods We performed a systematic review and frequentist network meta-analysis according to PRISMA (PROSPERO CRD420251164650). PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to December 17, 2025. Random-effects models were used as the primary analyses for overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS). Study-level subgroup analysis, network meta-regression, and sensitivity analyses were used to examine the robustness and comparability of the evidence. Results Thirty-four studies were included. The OS, RFS, and DSS networks contained 2,621, 2,173, and 1,274 participants, respectively. Compared with primary esophagectomy (ESO), ER followed by esophagectomy (ER+ESO) had an OS hazard ratio (HR) of 0.562 (95% CI 0.311-1.015; P = 0.056). The corresponding HRs were 0.480 for RFS (95% CI 0.235-0.983; P = 0.045) and 0.206 for DSS (95% CI 0.069-0.619; P = 0.005). No other strategy differed significantly from ESO. Global inconsistency was not detected for OS or DSS, whereas the RFS network showed significant between-design inconsistency. Study-level subgroup and network meta-regression analyses did not identify statistically significant effect modification by pathological-stage composition, T1b proportion, or lymphovascular invasion burden. Conclusions ER+ESO was associated with favorable RFS and DSS estimates in selected patients suitable for surgery, with a similar direction of effect for OS. These findings may support ER+ESO as an important post-ER treatment option when surgical tolerance is acceptable. ER followed by chemoradiotherapy may represent a clinically relevant organ-preserving strategy, particularly for patients in whom esophagectomy is not preferred or feasible. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251164650, identifier CRD420251164650.
Hongzhi He, Han-Lu Zhang, Haowen Lv et al.· Frontiers in Oncology· 0 citations
Purpose Active surveillance (AS) is an established management strategy for favorable-risk prostate cancer (PCa). In real-world practice, decisions to continue AS or active treatment (AT) are influenced by both disease-related and patient-related factors. This study aimed to identify factors associated with the transition from AS to AT in a large multicenter cohort. Materials and Methods We analyzed 716 patients with PCa managed with AS across 12 institutions. Baseline clinical characteristics, comorbidity burden assessed via the Charlson comorbidity index (CCI), performance status evaluated using the Eastern Cooperative Oncology Group (ECOG) score, and disease-related factors, including prostate-specific antigen (PSA), PSA density (PSAD), and magnetic resonance imaging findings, were collected. Cox proportional hazards regression was used to identify factors associated with conversion to AT. Results During a mean follow-up of 28.4 months, 224 patients (31.3%) transitioned from AS to AT, most frequently because of pathologic reclassification (60.3%). In multivariate analysis, maximum core involvement (hazard ratio [HR] 1.015, p=0.003) and PSAD ≥0.10 ng/mL/cm3 (HR 1.478, p=0.044) were independently associated with conversion to AT. Although ECOG performance status and CCI were not statistically significant in multivariate models, patients with poorer functional status or greater comorbidity burden remained on AS rather than proceeding to AT. Conclusions In this large multicenter study, PSAD was the strongest predictor of transition to AT during AS for PCa. Beyond disease-related factors, patient condition also appeared to influence real-world decisions about continuing AS.
Joongwon Choi, Chung-Un Lee, S. Jeon et al.· Investigative and Clinical U...· 0 citations
OBJECTIVE
The prognostic value of circulating tumor cells (CTCs) in colorectal cancer (CRC) remains debated. This meta-analysis evaluates their role in monitoring treatment response and predicting survival.
METHODS
We systematically searched multiple databases up to November 2025. Inclusion criteria comprised cohort studies involving CRC patients that assessed peripheral blood CTCs and reported outcomes such as CTC positivity/levels before and after treatment, progression-free survival (PFS), and overall survival (OS). Two reviewers independently extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale. The meta-analysis was performed using Stata 18.0, with pooled odds ratios (ORs), standardized mean differences (SMDs), and hazard ratios (HRs) calculated using fixed- or random-effects models based on heterogeneity assessed by the I² statistic. This study was registered in PROSPERO.
RESULTS
A total of 18 studies involving 2,838 CRC patients were included. The meta-analysis demonstrated a significant decrease in both the CTC-positive rate (OR=0.52, 95% CI 0.31-0.87) and CTC count (SMD=-0.32, 95% CI -0.42 to -0.21) following therapy. Compared to patients without CTC reduction, those with reduced CTCs exhibited significantly better progression-free survival (HR=2.41, 95% CI 1.75-3.31) and overall survival (HR=3.29, 95% CI 1.99-5.45). Furthermore, CTC-positive status, both before and after treatment, was consistently associated with inferior PFS and OS (all p < 0.0001).
CONCLUSIONS
CTCs can serve as a biomarker for monitoring CRC therapeutic efficacy, predicting prognosis, and guiding subsequent treatment.
Yuhao Wang, Shan Wang, Lin Yao et al.· Critical reviews in oncology...· 0 citations
In this single-centre cohort, AS discontinuation occurred early and at a rate higher than that of established international programmes, consistent with the institution’s initial AS experience.
I. Mykoniatis, Athanasios Papatzelos, Damianos Damon Dejan Nikolaou Nikolovski et al.· Journal of Personalized Medi...· 0 citations
Circulating tumor DNA (ctDNA) has demonstrated utility for treatment monitoring, risk stratification, and prognostication in colorectal cancer (CRC). However, substantial methodological heterogeneity across studies may influence its reported prognostic performance. Here, we systematically searched four databases up to October 2025. Eligible studies included patients with CRC who underwent mutation-based plasma ctDNA analysis reported as a binary variable (positive/negative) and provided hazard ratios (HRs) with 95% confidence intervals (95%CIs) for recurrence-free survival (RFS), disease-free survival (DFS), progression-free survival (PFS), or overall survival (OS). Pooled HRs were synthesized using random-effects meta-analysis. Thirty-seven studies met the inclusion criteria. ctDNA positivity was consistently associated with inferior outcomes across all survival endpoints, including OS (HR 3.52; 95%CI 2.42–5.13; p < 0.001; I2 = 74.4%), RFS (HR 4.90; 95%CI 3.54–6.79; p < 0.001; I2 = 83.5%), DFS (HR 4.41; 95%CI 2.96–6.55; p < 0.001; I2 = 84.7%), and PFS (HR 2.46; 95%CI 1.88–3.21; p < 0.001; I2 = 39.2%). The prognostic value of ctDNA was greatest in localized (stage I–III) disease, where it most likely reflects minimal residual disease (MRD). Post-treatment ctDNA demonstrated substantially greater prognostic value than baseline ctDNA, supporting its role in MRD assessment. Persistent ctDNA positivity following surgery and adjuvant chemotherapy identified patients at the highest risk of recurrence and death. Methodological factors were associated with differences in reported prognostic performance: tumor-informed assays outperformed tumor-agnostic assays, particularly in localized disease, while NGS-based approaches showed stronger prognostic performance than dPCR or qPCR. In conclusion, ctDNA positivity is strongly associated with adverse survival outcomes across CRC stages and clinical settings, supporting its role as a clinically relevant biomarker. However, methodological variability significantly influences the reported magnitude of this association, underscoring the need for standardized protocols and transparent reporting to facilitate comparison across studies and support reliable clinical implementation of ctDNA-guided management.
M. Nóbrega, Nivedita Kaorey, L. Godoy et al.· The journal of liquid biopsy· 0 citations
SEARCH STRATEGY AND SOURCES OF INFORMATION
MEDLINE, Embase and ClinicalTrials.gov were searched from database inception to May 2026 without language restriction, supplemented by hand-searching the proceedings of major oncology and radiation-oncology congress (2020-2026).
AIMS
Whether elective whole-pelvic radiotherapy (WPRT) improves outcomes over prostate-only radiotherapy (PORT) in high-risk localised prostate cancer remains an open question. We synthesised all phase 3 randomised trials and added a reconstructed individual-patient-data (IPD) analysis.
MATERIALS AND METHODS
We included phase III randomised trials of WPRT versus PORT. Trial-reported hazard ratios (HRs) were pooled using a random-effects meta-analysis, and individual-patient data were reconstructed (Guyot algorithm) and pooled. Outcomes were overall survival, biochemical/progression-free survival, and metastasis-free survival; risk of bias (RoB 2) and certainty (GRADE) were assessed for each outcome.
RESULTS
Five trials (5172 patients) were included. WPRT did not improve overall survival (HR, 1.07; 95% confidence interval [CI], 0.94 to 1.21; I2 = 0%; prediction interval, 0.92 to 1.24; reconstructed-IPD HR, 0.98; 0.80 to 1.20). The apparent benefit in biochemical/progression-free survival (HR, 0.84; 0.54 to 1.29) and metastasis-free survival (HR, 0.92; 0.54 to 1.57) was driven entirely by a single prostate-specific membrane antigen (PSMA)-staged, single-centre trial; excluding it, both became null (0.90; 0.77 to 1.06 and 1.00; 0.70 to 1.43). WPRT modestly increased late grade ≥2 genitourinary and gastrointestinal events without a meaningful severe-event excess. Certainty was moderate for overall survival and very low for both biochemical/progression-free and metastasis-free survival.
CONCLUSION
Current randomised evidence does not demonstrate sufficient benefit to support routine elective pelvic irradiation: WPRT does not improve overall survival, and its apparent benefit in progression-related endpoints is not reproducible across trials. POP-RT identifies a clinically plausible subgroup (patients with very-high nodal-risk who were PSMA-staged) in whom benefit is unproven and requires prospective validation in contemporary randomised trials.
J. Subiela, E. G. Sellés, F. L. Campos et al.· Clinics in oncology· 0 citations
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