Selective detection of histologically aggressive prostate cancer An Early Detection Research Network Prediction Model to Reduce Unnecessary Prostate Biopsies With Validation in the Prostate Cancer Prevention Trial
Selective detection of histologically aggressive prostate cancer An Early Detection Research Network Prediction Model to Reduce Unnecessary Prostate Biopsies With Validation in the Prostate Cancer Prevention Trial
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DOI：
10.1002/cncr.26396
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发表时间：
2012-05-15
期刊：
影响因子：
6.2
通讯作者：
Sanda, Martin G.
中科院分区：
文献类型：
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作者：
Williams, Stephen B.;Salami, Simpa;Sanda, Martin G.
背景：在随机试验中，由于前列腺特异性抗原（PSA）筛查，有限的生存获益和过度治疗表明，需要在活检前通过区分组织学侵袭性癌和惰性癌的风险来更严格地选择前列腺活检候选人。方法：在美国国家癌症研究所早期检测研究网络（N = 635）的多中心前瞻性队列中，对首次接受前列腺活检的受试者进行分析，以建立预测组织学侵袭性前列腺癌的模型。前列腺癌预防试验的对照组（N = 3833）用于验证预测模型的泛化性。结果：早期检测研究网络队列由男性组成，其中57%没有癌症，14%为惰性癌症，29%为侵袭性癌症。年龄、体重指数、前列腺癌家族史、直肠指检异常（DRE）、PSA密度（PSAD）与侵袭性癌相关（均P < 0.001）。早期检测研究网络模型在预测侵袭性癌症方面优于单独PSA（曲线下面积[AUC] = 0.81 vs 0.71, P < 0.01）。前列腺癌预防试验队列中的模型验证准确地识别出低（0.1 ng/mL/cc）或异常DRE的男性。当PSAD是
BACKGROUND: Limited survival benefit and excess treatment because of prostate-specific antigen (PSA) screening in randomized trials suggests a need for more restricted selection of prostate biopsy candidates by discerning risk of histologically aggressive versus indolent cancer before biopsy. METHODS: Subjects undergoing first prostate biopsy enrolled in a multicenter, prospective cohort of the National Cancer Institute Early Detection Research Network (N = 635) were analyzed to develop a model for predicting histologically aggressive prostate cancers. The control arm of the Prostate Cancer Prevention Trial (N = 3833) was used to validate the generalization of the predictive model. RESULTS: The Early Detection Research Network cohort was comprised of men among whom 57% had no cancer, 14% had indolent cancer, and 29% had aggressive cancer. Age, body mass index, family history of prostate cancer, abnormal digital rectal examination (DRE), and PSA density (PSAD) were associated with aggressive cancer (all P < .001). The Early Detection Research Network model outperformed PSA alone in predicting aggressive cancer (area under the curve [AUC] = 0.81 vs 0.71, P < .01). Model validation in the Prostate Cancer Prevention Trial cohort accurately identified men at low (0.1 ng/mL/cc or abnormal DRE. When PSAD is