评估4Kscore在预测前列腺癌主动监视进展方面的作用，独立于临床信息和Pirads评分
Evaluating 4Kscore's role in predicting progression on active surveillance for prostate cancer independently of clinical information and PIRADS score
影响因子:5.80000
发表日期:2025 Mar
作者:
Helen Y Hougen, Isildinha M Reis, Sunwoo Han, Nachiketh Soodana Prakash, Jamie Thomas, Radka Stoyanova, R Patricia Castillo, Oleksandr N Kryvenko, Chad R Ritch, Bruno Nahar, Mark L Gonzalgo, Sandra M Gaston, Matthew C Abramowitz, Alan Dal Pra, Brandon A Mahal, Alan Pollack, Dipen J Parekh, Sanoj Punnen
摘要
4KSCORE用于帮助前列腺活检的决定，但是在基于磁共振成像（MRI）的方案中，尚未研究其在主动监视（AS）中的作用。我们的目标是评估基于前瞻性MRI的方案的4KSCORE与经历的男性进展之间的关联。这是一项单臂，单臂，非治疗性的，介入的介入试验，对2014 - 2020年之间招募的166名活检证实的前列腺癌。将患者置于试验中作为方案的试验，包括年度多参数（MP）MRI，前列腺活检和4KSCORE诊断后的48个月。我们分析了协议定义和级别进展，并随后进行监视活检。166例患者，83名（50％）男性根据方案的进展，其中41例（占整个队列的24.7％）按等级进展。在验证活检时，与4KSCORE <20％的男性≥20％的男性≥20％的成绩风险更高（OR = 4.04，95％CI：1.05-15.59：1.05-15.59，p = 0.043，P = 0.043）在调整了国家综合癌症网络（NCCN）风险和基线pirads的评分后。在监视活检中，最近的4KSCORE≥20％明显预测（OR = 2.61，95％CI：1.03-6.63，1.03-6.63，p = 0.044）和年级进展（OR = 5.13，95％CI：1.63-16.11：1.63-16.11，p = 0.005，及其基础4KSORE 4KSORE 4KSORE 4KSORE的预测级别，监视活检时的每项协议和等级进展。
Abstract
4Kscore is used to aid the decision for prostate biopsy, however its role in active surveillance (AS) has not been investigated in a magnetic resonance imaging (MRI)-based protocol. Our objective was to assess the association between 4Kscore and progression in men undergoing AS on a prospective MRI-based protocol.This was a single-institution, single-arm, non-therapeutic, interventional trial of 166 men with biopsy-confirmed prostate cancer enrolled between 2014-2020. Patients were placed on a trial-mandated AS protocol including yearly multiparametric (mp)MRI, prostate biopsy, and 4Kscore followed for 48 months after diagnosis. We analyzed protocol-defined and grade progression at confirmatory and subsequent surveillance biopsies.Out of 166 patients, 83 (50%) men progressed per protocol and of them 41 (24.7% of whole cohort) progressed by grade. At confirmatory biopsy, men with a baseline 4Kscore ≥ 20% had a higher risk of grade progression compared to those with 4Kscore < 20% (OR = 4.04, 95% CI: 1.05-15.59, p = 0.043) after adjusting for National Comprehensive Cancer Network (NCCN) risk and baseline PIRADS score. At surveillance biopsies, most recent 4Kscore ≥ 20% significantly predicted per protocol (OR = 2.61, 95% CI: 1.03-6.63, p = 0.044) and grade progression (OR = 5.13, 95% CI: 1.63-16.11, p = 0.005).For patients on AS, baseline 4Kscore predicted grade progression at confirmatory biopsy, and most recent 4Kscore predicted per-protocol and grade progression at surveillance biopsy.