Modeling grade progression in an active surveillance study.
Modeling grade progression in an active surveillance study.
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DOI：
10.1002/sim.6003
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发表时间：
2014-03-15
影响因子：
2
通讯作者：
Etzioni, Ruth
中科院分区：
文献类型：
--
作者：
Inoue, Lurdes Y. T.;Trock, Bruce J.;Partin, Alan W.;Carter, Herbert B.;Etzioni, Ruth
用Gleason评分评估的前列腺癌分级描述了肿瘤组织和细胞出现的异常程度，并且它是疾病进展的重要预后指标。前列腺肿瘤是否会改变分级是一个对筛查和治疗有影响的问题。作为主动监测（AS）的一部分，定期进行活检的男性已经可以获得关于肿瘤分级随时间推移的经验数据。然而，活检分级容易发生错误分类。在这篇文章中，我们开发了一个模型，允许估计的时间等级变化，同时占误分类错误活检等级。我们使用的错误分类率研究前列腺癌活检后，根治性前列腺切除术。在贝叶斯框架内估计从真正的低度疾病到高度疾病的转变时间。我们将我们的模型应用于约翰霍普金斯大学AS患者队列中627例患者的活检分级的系列观察，这些患者每年进行活检，如果活检有任何疾病进展的证据，则进行治疗。我们考虑不同的先验分布的时间，真正的年级进展。根据既往情况，研究入组后10年内年级进展的估计可能性范围为12%至24%。我们的结论是，等级错误分类率的知识，允许确定真正的等级进展率之间的男性AS连续活检。虽然我们的结果对先前的规范敏感，但它们表明在患者群体的非平凡部分中，肿瘤分级可以进展。
Prostate cancer grade, assessed with the Gleason score, describes how abnormal the tumor tissue and cells appear and it is an important prognostic indicator of disease progression. Whether prostate tumors change grade is a question that has implications for screening and treatment. Empirical data on tumor grade over time have become available from men biopsied regularly as part of active surveillance (AS). However, biopsy grade is subject to misclassification. In this article we develop a model that allows for estimation of the time of grade change while accounting for the misclassification error from biopsy grade. We use misclassification rates from studies of prostate cancer biopsies followed by radical prostatectomy. Estimation of the transition times from true low-grade to high-grade disease is conducted within a Bayesian framework. We apply our model to serial observations on biopsy grade among 627 cases enrolled in a cohort of AS patients at Johns Hopkins University who were biopsied annually and referred to treatment if there was any evidence of disease progression on biopsy. We consider different prior distributions for the time to true grade progression. The estimated likelihood of grade progression within 10 years of study entry ranges from 12% to 24% depending on the prior. We conclude that knowledge of rates of grade misclassification allows for determination of true grade progression rates among men with serial biopsies on AS. While our results are sensitive to prior specifications they indicate that in a non-trivial fraction of the patient population, tumor grade can progress.
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影响因子：
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