评估 4Kscore 在预测前列腺癌主动监测进展方面的作用，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.
发表日期：2024 Sep 27
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
来源：
PROSTATE CANCER AND PROSTATIC DISEASES
摘要：
4Kscore 用于帮助做出前列腺活检的决定，但其在主动监测 (AS) 中的作用尚未在基于磁共振成像 (MRI) 的方案中进行研究。我们的目标是根据基于 MRI 的前瞻性方案评估 4Kscore 与接受 AS 的男性进展之间的关联。这是一项单机构、单组、非治疗性介入试验，入组了 166 名经活检确诊为前列腺癌的男性2014年至2020年之间。患者接受试验规定的 AS 方案，包括每年进行多参数 (mp)MRI、前列腺活检和诊断后 48 个月的 4Kscore 随访。我们分析了验证性活检和随后的监测活检中方案定义的进展和分级进展。在 166 名患者中，83 名 (50%) 男性按照方案进展，其中 41 人（整个队列的 24.7%）按分级进展。在验证性活检中，根据国家综合癌症调整后，基线 4Kscore ≥20% 的男性与 4Kscore< 20% 的男性相比，分级进展的风险更高（OR = 4.04，95% CI：1.05-15.59，p = 0.043）网络 (NCCN) 风险和基线 PIRADS 评分。在监测活检中，根据方案，最近 4Kscore ≥ 20% 显着预测（OR = 2.61，95% CI：1.03-6.63，p = 0.044）和分级进展（OR = 5.13，95% CI：1.63-16.11，p = 0.005） ).对于 AS 患者，基线 4Kscore 预测确认性活检时的分级进展，最新 4Kscore 预测监测活检时符合方案和分级的进展。© 2024。作者，获得 Springer Nature Limited 的独家许可。
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.© 2024. The Author(s), under exclusive licence to Springer Nature Limited.