基因组检测后中间风险前列腺癌患者的主动监测选择及3年持续性
Active surveillance selection and 3-year durability in intermediate-risk prostate cancer following genomic testing
影响因子:5.80000
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
摘要
基因组检测为前列腺癌的临床和病理特征提供风险分层信息，有助于临床医生和患者共同决策采用主动监测（AS）或根治性治疗（DT）。本研究旨在评估接受Prolaris检测的局部中等风险前列腺癌患者的初始AS选择及3年内的持续性。采用回顾性观察队列研究，纳入2015年9月至2018年12月期间诊断的3208例患者，来自10个研究中心。Prolaris结合临床细胞周期风险评分（在诊断活检时测定），根据Prolaris阈值将患者分为建议AS或建议DT。比较两组的AS选择率和3年持续性，采用单变量和多变量逻辑回归模型及Cox比例风险模型分析影响治疗决策和持续性的重要因素。结果显示，由Prolaris建议AS的患者，其初始AS选择率约为建议DT组的两倍（p<0.0001），且3年后仍持续在AS的比例是建议DT组的1.5倍（p<0.0001）。在考虑CAPRA或Gleason评分后，Prolaris的治疗建议仍为影响初始AS和持续性的重要预测因子。Prolaris显著增强了临床风险分层的指导价值，有助于合理制定治疗方案。建议Prolaris推荐的中等风险患者更倾向于最初选择AS，且在诊断后3年内持续在AS的比例更高。
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.