Ability of a Genomic Classifier to Predict Metastasis and Prostate Cancer-specific Mortality after Radiation or Surgery based on Needle Biopsy Specimens
Ability of a Genomic Classifier to Predict Metastasis and Prostate Cancer-specific Mortality after Radiation or Surgery based on Needle Biopsy Specimens
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DOI：
10.1016/j.eururo.2017.05.009
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发表时间：
2017-11-01
期刊：
影响因子：
23.4
通讯作者：
Klein, Eric A.
中科院分区：
文献类型：
--
作者：
Nguyen, Paul L.;Haddad, Zaid;Klein, Eric A.
背景资料：Decipher是一种经过验证的基因组分类器，用于确定根治性前列腺切除术（RP）后转移的生物学潜能。目的：评估活检Decipher预测主要接受RP或放射治疗（RT）的中高危患者转移和前列腺癌特异性死亡率（PCSM）的能力。设计、设置和参与者：235例接受RP（n = 105）或RT +/-雄激素剥夺治疗（n = 130）的患者，其基因组表达谱来自7个三级转诊中心的诊断活检标本。结果测量和统计分析：转移和PCSM分别是本研究的主要和次要结果。考克斯分析和C指数被用来评估Decipher.Results和局限性的性能：与中位随访6年的删失患者中，34例发生转移，11例死于前列腺癌。在多变量分析中，在调整临床变量后，活检Decipher仍然是转移的重要预测因子（风险比：1.37/10%评分增加，95%置信区间[CI]：1.06-1.78，p = 0.018）。对于预测活检后5年的转移，前列腺癌风险评估评分的c指数为0.60（95% CI：0.50-0.69），而前列腺癌风险评估加活检Decipher的c指数为0.71（95% CI：0.60-0.82）。国家综合癌症网络风险组的c指数为0.66（95% CI：0.53-0.77），而国家综合癌症网络加活检Decipher的c指数为0.74（95% CI：0.66-0.82）。活检解密是PCSM的重要预测因子（风险比：1.57/10%评分增加，95%CI：1.03-2.48，p = 0.037），Decipher低、中和高的5年PCSM发生率分别为0%、0%和9.4%。Biopsy Decipher从接受一线RT或RP治疗的主要中高危男性的诊断性活检标本中预测转移和PCSM。患者总结：Biopsy Decipher预测诊断活检标本的转移和前列腺癌特异性死亡风险。(C)2017年欧洲泌尿外科协会。由爱思唯尔公司出版
Background: Decipher is a validated genomic classifier developed to determine the biological potential for metastasis after radical prostatectomy (RP).Objective: To evaluate the ability of biopsy Decipher to predict metastasis and Prostate cancer-specific mortality (PCSM) in primarily intermediate- to high-risk patients treated with RP or radiation therapy (RT).Design, setting, and participants: Two hundred and thirty-five patients treated with either RP (n = 105) or RT +/- androgen deprivation therapy (n = 130) with available genomic expression profiles generated from diagnostic biopsy specimens from seven tertiary referral centers. The highest-grade core was sampled and Decipher was calculated based on a locked random forest model.Outcome measurements and statistical analysis: Metastasis and PCSM were the primary and secondary outcomes of the study, respectively. Cox analysis and c-index were used to evaluate the performance of Decipher.Results and limitations: With a median follow-up of 6 yr among censored patients, 34 patients developed metastases and 11 died of prostate cancer. On multivariable analysis, biopsy Decipher remained a significant predictor of metastasis (hazard ratio: 1.37 per 10% increase in score, 95% confidence interval [CI]: 1.06-1.78, p = 0.018) after adjusting for clinical variables. For predicting metastasis 5-yr post-biopsy, Cancer of the Prostate Risk Assessment score had a c-index of 0.60 (95% CI: 0.50-0.69), while Cancer of the Prostate Risk Assessment plus biopsy Decipher had a c-index of 0.71 (95% CI: 0.60-0.82). National Comprehensive Cancer Network risk group had a c-index of 0.66 (95% CI: 0.53-0.77), while National Comprehensive Cancer Network plus biopsy Decipher had a c-index of 0.74 (95% CI: 0.66-0.82). Biopsy Decipher was a significant predictor of PCSM (hazard ratio: 1.57 per 10% increase in score, 95% CI: 1.03-2.48, p = 0.037), with a 5-yr PCSM rate of 0%, 0%, and 9.4% for Decipher low, intermediate, and high, respectively.Conclusions: Biopsy Decipher predicted metastasis and PCSM from diagnostic biopsy specimens of primarily intermediate- and high- risk men treated with first-line RT or RP.Patient summary: Biopsy Decipher predicted metastasis and prostate cancer-specific mortality risk from diagnostic biopsy specimens. (C) 2017 European Association of Urology. Published by Elsevier B.V.