Impact of a Genomic Classifier of Metastatic Risk on Postprostatectomy Treatment Recommendations by Radiation Oncologists and Urologists
Impact of a Genomic Classifier of Metastatic Risk on Postprostatectomy Treatment Recommendations by Radiation Oncologists and Urologists
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DOI：
10.1016/j.urology.2015.04.004
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发表时间：
2015-07-01
期刊：
影响因子：
2.1
通讯作者：
Feng, Felix Y.
中科院分区：
文献类型：
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作者：
Nguyen, Paul L.;Shin, Heesun;Feng, Felix Y.
目的评估预测直肠癌切除术后转移风险的基因组分类器（GC）如何影响放射肿瘤学家和泌尿科医生提出的辅助治疗建议。这2个专业往往不同意posterectomy的辅助治疗recommendations.MATERIALS和方法26放射肿瘤学家和20泌尿生殖肿瘤学专业知识审查去识别的临床结果，从11例根治性膀胱切除术后，辅助治疗的建议。相同的病例随后被随机分配，并使用临床信息和GC检测结果一起做出治疗建议。结果仅使用临床信息，泌尿科医生做出的决定中有42%建议观察，放射肿瘤科医生做出的决定中有23%建议观察（P < .0001）。GC测试结果分别改变了放射肿瘤学家和泌尿科医生35%和45%的治疗建议。多变量分析显示，GC风险是影响两个专业治疗建议的最强因素，放射肿瘤科医生和泌尿科医生的调整优势比分别为4.17（95%置信区间[CI]，2.26-7.70）和6.51（95% CI，4.29-9.88）。GC结果表明高转移风险导致强化治疗，而低转移风险导致不太积极的建议。GC结果增加了治疗建议的跨学科一致性，因为泌尿科医生与放射肿瘤科医生推荐辅助治疗的几率从0.27增加到0.27。（95% CI，0.17-0.44）至0.46（95%CI，0.29-0.75）结论GC试验显著影响辅助性直肠癌切除术后治疗建议，减少放射肿瘤学家和泌尿科医生之间的分歧，并有可能提高个性化的切除术后护理。(C)2015 Elsevier Inc.
OBJECTIVE To evaluate how a genomic classifier (GC) that predicts the risk of metastasis after prostatectomy would impact adjuvant treatment recommendations made by radiation oncologists and urologists. The 2 specialties often disagree about postprostatectomy adjuvant treatment recommendations.MATERIALS AND METHODS Twenty-six radiation oncologists and 20 urologists with genitourinary oncology expertise reviewed de-identified clinical results from 11 patients after radical prostatectomy and made adjuvant treatment recommendations. The same cases were later randomized and reassigned, and treatment recommendations were made using the clinical information and GC test results together.RESULTS Using clinical information alone, observation was recommended in 42% of decisions made by urologists vs 23% by radiation oncologists (P < .0001). The GC test results altered 35% and 45% of treatment recommendations made by radiation oncologists and urologists, respectively. Multivariate analysis showed GC risk was the strongest factor influencing treatment recommendations by both specialties, with an adjusted odds ratio of 4.17 (95% confidence interval [CI], 2.26-7.70) and 6.51 (95% CI, 4.29-9.88) for radiation oncologists and urologists, respectively. GC results indicating high metastatic risk resulted in intensification of treatment, whereas low metastatic risk resulted in less aggressive recommendations. The GC results increased interdisciplinary agreement in treatment recommendations, as the odds of a recommendation for adjuvant treatment by urologists vs radiation oncologists increased from 0.27 (95% CI, 0.17-0.44) to 0.46 (95% CI, 0.29-0.75) after results of the GC test were available.CONCLUSION The GC test significantly influenced adjuvant postprostatectomy treatment recommendations, reduced disagreement between radiation oncologists and urologists, and has the potential to enhance personalization of postprostatectomy care. (C) 2015 Elsevier Inc.