基因组检测后中等风险前列腺癌的主动监测筛选与3年持久性
Active surveillance selection and 3-year durability in intermediate-risk prostate cancer following genomic testing
DOI 原文链接
用sci-hub下载
如无法下载，请从 Sci-Hub 选择可用站点尝试。
发表日期:2025 Jun
作者:
Lauren Lenz, Wyatt Clegg, Diana Iliev, Chelsea R Kasten, Howard Korman, Todd M Morgan, Jason Hafron, Alexander DeHaan, Carl Olsson, Ronald F Tutrone, Timothy Richardson, Kevin Cline, Paul M Yonover, Jeff Jasper, Todd Cohen, Robert Finch, Thomas P Slavin, Alexander Gutin
DOI:
10.1038/s41391-024-00888-y
摘要
基因组检测可以为前列腺癌的临床病理特征提供风险分层信息，帮助临床医生与患者在采用主动监测（AS）或根治性治疗（DT）之间做出共同的医疗决策。本研究考察了在治疗决策前接受Prolaris检测的局部中等风险前列腺癌患者的初始主动监测选择情况及3年主动监测的持久性。本回顾性观察队列研究纳入了2015年9月至2018年12月期间在10个研究地点诊断并接受Prolaris检测的3208名患者。Prolaris利用在诊断活检时计算的临床细胞周期风险评分，根据Prolaris主动监测阈值（低于阈值者建议主动监测，超过阈值者建议根治性治疗）对患者进行风险分层。比较了Prolaris检测推荐主动监测与根治性治疗的患者的主动监测选择率及3年持久率。采用单变量和多变量逻辑回归模型以及Cox比例风险模型，分别以分子和临床变量作为预测初始治疗决策和主动监测持久性的因素。Prolaris检测推荐主动监测的患者的主动监测选择率比推荐根治性治疗者高约两倍（p < 0.0001）。Prolaris检测推荐主动监测的患者的3年主动监测持续率比建议根治性治疗的患者高约1.5倍（p < 0.0001）。在考虑CAPRA评分或Gleason评分后，Prolaris的治疗建议仍是主动监测初始选择和持久性的统计学显著预测因素。Prolaris显著增强了临床风险分层的价值，有助于治疗决策。被Prolaris建议进行主动监测的中等风险前列腺癌患者更倾向于最初选择主动监测，并在诊断后3年仍维持在主动监测状态，优于被建议根治性治疗的患者。
Abstract
Genomic testing can add risk stratification information to clinicopathological features in prostate cancer, aiding in shared medical decision-making between the clinician and patient regarding whether active surveillance (AS) or definitive treatment (DT) is most appropriate. Here we examined initial AS selection and 3-year AS durability in patients diagnosed with localized intermediate-risk prostate cancer who underwent Prolaris testing before treatment decision-making.This retrospective observational cohort study included 3208 patients from 10 study sites who underwent Prolaris testing at diagnosis from September 2015 to December 2018. Prolaris utilizes a combined clinical cell cycle risk score calculated at diagnostic biopsy to stratify patients by the Prolaris AS threshold (below threshold, patient recommended to AS or above threshold, patient recommended to DT). AS selection rates and 3-year AS durability were compared in patients recommended to AS or DT by Prolaris testing. Univariable and multivariable logistic regression models and Cox proportional hazard models were used with molecular and clinical variables as predictors of initial treatment decision and AS durability, respectively.AS selection was ~2 times higher in patients recommended to AS by Prolaris testing than in those recommended to DT (p < 0.0001). Three-year AS durability was ~1.5 times higher in patients recommended to AS by Prolaris testing than in those recommended to DT (p < 0.0001). Prolaris treatment recommendation remained a statistically significant predictor of initial AS selection and AS durability after accounting for CAPRA or Gleason scores.Prolaris added significant information to clinical risk stratification to aid in treatment decision making. Intermediate-risk prostate cancer patients who were recommended to AS by Prolaris were more likely to initially pursue AS and were more likely to remain on AS at 3 years post-diagnosis than patients recommended to DT.