Preoperative prostate health index predicts poor pathologic outcomes of radical prostatectomy in patients with biopsy-detected low-risk patients prostate cancer: results from a Chinese prospective cohort
Preoperative prostate health index predicts poor pathologic outcomes of radical prostatectomy in patients with biopsy-detected low-risk patients prostate cancer: results from a Chinese prospective cohort
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术前前列腺健康指数可预测活检检测出的低风险前列腺癌患者根治性前列腺切除术的不良病理结果：来自中国前瞻性队列的结果
DOI：
10.1038/s41391-017-0002-0
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发表时间：
2018-04-01
影响因子：
4.8
通讯作者：
Ye, Ding-Wei
中科院分区：
文献类型：
--
作者：
Tang, Bo;Han, Cheng-Tao;Ye, Ding-Wei
目的 探讨前列腺健康指数（PHI）在预测中国低危前列腺癌（PCa）患者根治性前列腺切除术（RP）病理结果中的表现。方法根据国际前列腺癌研究主动监测（PRIAS）标准，对2013年9月至2017年1月在一个三级中心连续接受RP治疗的140例低危PCa患者的数据进行前瞻性检查。所有患者均符合主动监测条件，但接受了 RP。收集临床和病理数据。 Logistic 回归用于评估 PHI 和 RP 结果之间的关联。受试者工作曲线下面积（AUC）用于评估不同模型的准确性。采用决策曲线分析来评估基于模型决策的潜在临床实用性。结果只有44例（31.4%）患者最终被证实患有器官局限性Gleason≤6 PCa。低 PHI 显着预测器官局限性 Gleason ≤6 PCa (p= 0.001)，而 tPSA 和 f/tPSA 与最终病理学无关。在多变量分析中，加入PHI显着提高了预测准确性（AUC = 0.767，95% Cl 0.685–0.849，p< 0.001）。结论主动监测的PRIAS标准可能不适合中国PCa患者。将 PHI 添加到 PRIAS 模型改善了预后性能。如果在未来更大规模的多中心研究中得到证实，PHI 可能会帮助我们在中国识别出符合 AS 治疗条件的患者。
ObjectiveTo determine the performance of the prostate health index (PHI) in predicting pathologic outcomes of radical prostatectomy (RP) in Chinese patients with low-risk prostate cancer (PCa).MethodsOf all consecutive patients who underwent RP in one tertiary center from September 2013 to January 2017, we prospectively examined the data of 140 patients with low-risk PCa based on the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria. All patients were eligible for active surveillance, but underwent RP. Clinical and pathological data were collected. Logistic regression was used to evaluate the associations between the PHI and outcome of RP. The area under the receiver operating curve (AUC) was used to evaluate the accuracy of different models. Decision curve analysis was used to evaluate the potential clinical usefulness of making model-based decisions.ResultsOnly 44 (31.4%) patients were finally confirmed to have organ-confined Gleason ≤6 PCa. A low PHI was significantly predictive of organ-confined Gleason ≤6 PCa (p= 0.001), while tPSA and f/tPSA were not associated with final pathology. In the multivariate analyses, addition of the PHI significantly increased the predictive accuracy (AUC = 0.767, 95% Cl 0.685–0.849,p< 0.001).ConclusionThe PRIAS criteria for active surveillance may not suitable for Chinese patients with PCa. Addition of the PHI to the PRIAS models improved the prognostic performance. If confirmed in future larger and multicenter studies, PHI may help us to identify patients eligible for AS in China.