Precision Medicine in Active Surveillance for Prostate Cancer: Development of the Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator
Precision Medicine in Active Surveillance for Prostate Cancer: Development of the Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator
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DOI：
10.1016/j.eururo.2015.03.023
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发表时间：
2015-12-01
期刊：
影响因子：
23.4
通讯作者：
Lin, Daniel W.
中科院分区：
文献类型：
--
作者：
Ankerst, Donna P.;Xia, Jing;Lin, Daniel W.
背景：接受主动监测 (AS) 的男性面临重复的活检。大多数活检标本不会显示疾病进展或改变管理。此类活检无助于患者管理，并且可能致病且成本高昂。目的：利用当代 AS 前瞻性试验开发预测 AS 活检结果的工具。设计、设置和参与者：活检样本（中位数：2；范围：每位患者 2-9）来自参与 Canary 前列腺主动监测研究的 859 名男性和 Gleason 6 前列腺癌（中位随访时间：35.8 个月；范围：分析结果测量和统计分析：使用逻辑回归来预测进展，定义为格里森评分从= 7增加或癌症阳性核心百分比从< 34%增加到> = 34%。进行五倍内部交叉验证来评估受试者工作特征曲线下的面积 (AUC)。 结果和局限性：活检中进展的统计学上显着的危险因素是前列腺特异性抗原（比值比 [OR]：1.045；95% 置信区间 [CI]，1.028-1.063）、最近活检中癌症阳性核心的百分比（OR：1.401；95% CI， 1.301-1.508），以及至少一次既往活检呈阴性的病史（OR：0.524；95% CI，0.417-0.659）。结合这些因素加上年龄和自上次活检以来的月数的多变量预测模型达到了 72.4% 的 AUC。 结论：结合现有的临床测量方法可以对考虑进行 AS 前列腺活检的患者进行分层。可以估计进展或升级的风险并将其纳入临床实践。患者摘要：金丝雀早期检测研究网络主动监测活检风险计算器是一种在线工具，可用于指导患者做出有关后续前列腺活检的决策。 (C) 2015 年欧洲泌尿外科协会。由 Elsevier B.V 出版。保留所有权利。
Background: Men on active surveillance (AS) face repeated biopsies. Most biopsy specimens will not show disease progression or change management. Such biopsies do not contribute to patient management and are potentially morbid and costly.Objective: To use a contemporary AS prospective trial to develop a tool to predict AS biopsy outcomes.Design, setting, and participants: Biopsy samples (median: 2; range: 2-9 per patient) from 859 men participating in the Canary Prostate Active Surveillance Study and with Gleason 6 prostate cancer (median follow-up: 35.8 mo; range: 3.0-148.7 mo) were analyzed.Outcome measurements and statistical analysis: Logistic regression was used to predict progression, defined as an increase in Gleason score from = 7 or increase in percentage of cores positive for cancer from < 34% to >= 34%. Fivefold internal cross-validation was performed to evaluate the area under the receiver operating characteristic curve (AUC).Results and limitations: Statistically significant risk factors for progression on biopsy were prostate-specific antigen (odds ratio [OR]: 1.045; 95% confidence interval [CI], 1.028-1.063), percentage of cores positive for cancer on most recent biopsy (OR: 1.401; 95% CI, 1.301-1.508), and history of at least one prior negative biopsy (OR: 0.524; 95% CI, 0.417-0.659). A multivariable predictive model incorporating these factors plus age and number of months since last biopsy achieved an AUC of 72.4%.Conclusions: A combination of readily available clinical measures can stratify patients considering AS prostate biopsy. Risk of progression or upgrade can be estimated and incorporated into clinical practice.Patient summary: The Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator, an online tool, can be used to guide patient decision making regarding followup prostate biopsy. (C) 2015 European Association of Urology. Published by Elsevier B. V. All rights reserved.