Risk Assessment for Prostate Cancer Metastasis and Mortality at the Time of Diagnosis
Risk Assessment for Prostate Cancer Metastasis and Mortality at the Time of Diagnosis
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DOI：
10.1093/jnci/djp122
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发表时间：
2009-06-16
影响因子：
10.3
通讯作者：
Carroll, Peter R.
中科院分区：
文献类型：
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作者：
Cooperberg, Matthew R.;Broering, Jeanette M.;Carroll, Peter R.
尽管已经发布了许多用于评估前列腺癌风险的工具，但大多数工具仅用于预测生化复发，通常是在单一指定治疗后。我们评估了前列腺癌风险评估（CAPRA）评分的准确性，CAPRA评分以前被证实可以预测根治性前列腺切除术后的病理和生化结果，预测转移，前列腺癌特异性死亡率和全因死亡率。我们研究了前列腺癌战略泌尿学研究奋进登记处的10627名临床局限性前列腺癌男性，接受了原发性根治性乳腺癌切除术、放射治疗（外照射或间质性）、雄激素剥夺单药治疗或观察等待/主动监测，并且在治疗后至少随访6个月。根据前列腺特异性抗原水平、Gleason评分、癌症阳性活检针百分比、临床肿瘤分期和诊断时的年龄计算诊断时的CAPRA评分。采用Kaplan-Meier分析研究生存率。CAPRA评分增加与骨转移、癌症特异性死亡率和全因死亡率之间的相关性通过比例风险回归进行检查，并对主要治疗进行调整;对于全因死亡率，分析还包括年龄和合并症的调整。在10627例患者中，311例（2.9%）男性发生骨转移，251例（2.4%）死于前列腺癌，1582例（14.9%）死于其他原因。CAPRA评分每增加一分，骨转移增加（骨转移的风险比[HR]= 1.47，95%置信区间[CI] = 1.39 - 1.56），癌症特异性死亡率（前列腺癌死亡的HR = 1.39，95% CI = 1.31至1.48）和全因死亡率（死亡的HR = 1.13，95% CI = 1.10至1.16）。CAPRA评分在预测转移（c-index = 0.78）、癌症特异性死亡率（c-index = 0.80）和全因死亡率（c-index = 0.71）方面是准确的。在一个大型临床局限性前列腺癌患者队列中，CAPRA评分预测临床前列腺癌终点具有良好的准确性。这些结果支持CAPRA评分作为研究和临床实践的风险评估和分层工具的价值。
Although many tools for the assessment of prostate cancer risk have been published, most are designed to predict only biochemical recurrence, usually after a single specified treatment. We assessed the accuracy of the Cancer of the Prostate Risk Assessment (CAPRA) score, which was validated previously to predict pathological and biochemical outcomes after radical prostatectomy, to predict metastases, prostate cancer-specific mortality, and all-cause mortality.We studied 10 627 men with clinically localized prostate cancer in the Cancer of the Prostate Strategic Urologic Research Endeavor registry, who underwent primary radical prostatectomy, radiation therapy (external beam or interstitial), androgen deprivation monotherapy, or watchful waiting/active surveillance, and had at least 6 months of follow-up after treatment. CAPRA scores were calculated at diagnosis from the prostate-specific antigen level, Gleason score, percentage of biopsy cores that were positive for cancer, clinical tumor stage, and age at diagnosis. Survival was studied with Kaplan-Meier analyses. Associations between increasing CAPRA scores and bone metastasis, cancer-specific mortality, and all-cause mortality were examined by use of proportional hazards regression, with adjustment for primary treatment; for all-cause mortality, the analysis also included adjustment for age and comorbidity. Accuracy of the CAPRA score was assessed with the concordance (c)-index.Among the 10 627 patients, 311 (2.9%) men developed bone metastases, 251 (2.4%) died of prostate cancer, and 1582 (14.9%) died of other causes. Each single-point increase in the CAPRA score was associated with increased bone metastases (hazard ratio [HR] for bone metastases = 1.47, 95% confidence interval [CI] = 1.39 to 1.56), cancer-specific mortality (HR for prostate cancer death = 1.39, 95% CI = 1.31 to 1.48), and all-cause mortality (HR for death = 1.13, 95% CI = 1.10 to 1.16). The CAPRA score was accurate for predicting metastases (c-index = 0.78), cancer-specific mortality (c-index = 0.80), and all-cause mortality (c-index = 0.71).In a large cohort of patients with clinically localized prostate cancer who were managed with one of five primary modalities, the CAPRA score predicted clinical prostate cancer endpoints with good accuracy. These results support the value of the CAPRA score as a risk assessment and stratification tool for both research studies and clinical practice.