评估4Kscore在预测前列腺癌在主动监测中的进展中的作用，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

PROSTATE CANCER AND PROSTATIC DISEASES

影响因子:5.8

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

DOI: 10.1038/s41391-024-00898-w

摘要

4Kscore用于辅助前列腺活检的决策，但其在基于磁共振成像（MRI）方案中的主动监测（AS）中的作用尚未被研究。我们的目标是评估4Kscore与接受AS的男性患者中疾病进展的关系，此为一项前瞻性MRI方案的单中心单臂非治疗性干预试验，纳入2014-2020年间确诊前列腺癌的166名患者。患者遵循试验规定的AS方案，包括每年多参数MRI（mpMRI）、前列腺活检和4Kscore检测，随访48个月。分析确认和随访活检中的协议定义和等级进展情况。在166名患者中，83名（50%）按方案进展，其中41名（占全部队列的24.7%）按等级进展。确认活检时，基线4Kscore≥20%的患者相较于4Kscore<20%的患者，等级进展风险较高（OR=4.04，95% CI：1.05-15.59，p=0.043），调整了NCCN风险和基线PIRADS评分。随访活检中，最新4Kscore≥20%的患者显著预测按方案（OR=2.61，95% CI：1.03-6.63，p=0.044）及等级进展（OR=5.13，95% CI：1.63-16.11，p=0.005）。对于接受AS的患者，基线4Kscore可以预测确认活检的等级进展，最新4Kscore则可以预测随访活检中的按方案和等级进展。

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.