domingo, 28 de mayo de 2017

Ability of a Genomic Classifier to Predict Metastasis and Prostate Cancer-specific Mortality after Radiation or Surgery based on Needle Biopsy Spec... - PubMed - NCBI

2017 May 18. pii: S0302-2838(17)30390-1. doi: 10.1016/j.eururo.2017.05.009. [Epub ahead of print]

Ability of a Genomic Classifier to Predict Metastasis and Prostate Cancer-specific Mortality after Radiation or Surgery based on Needle Biopsy Specimens.

Nguyen PL1, Haddad Z2, Ross AE3, Martin NE4, Deheshi S2, Lam LLC2, Chelliserry J2, Tosoian JJ3, Lotan TL3, Spratt DE5, Stoyanova RS6, Punnen S6, Ong K2, Buerki C2, Aranes M2, Kolisnik T2, Margrave J2, Yousefi K2, Choeurng V2, Davicioni E2, Trock BJ3, Kane CJ7, Pollack A6, Davis JW8, Feng FY9, Klein EA10.

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Abstract

BACKGROUND:

Decipher is a validated genomic classifier developed to determine the biological potential for metastasis after radical prostatectomy (RP).

OBJECTIVE:

To evaluate the ability of biopsy Decipher to predict metastasis and Prostate cancer-specific mortality (PCSM) in primarily intermediate- to high-risk patients treated with RP or radiation therapy (RT).

DESIGN, SETTING, AND PARTICIPANTS:

Two hundred and thirty-five patients treated with either RP (n=105) or RT±androgen deprivation therapy (n=130) with available genomic expression profiles generated from diagnostic biopsy specimens from seven tertiary referral centers. The highest-grade core was sampled and Decipher was calculated based on a locked random forest model.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

Metastasis and PCSM were the primary and secondary outcomes of the study, respectively. Cox analysis and c-index were used to evaluate the performance of Decipher.

RESULTS AND LIMITATIONS:

With a median follow-up of 6 yr among censored patients, 34 patients developed metastases and 11 died of prostate cancer. On multivariable analysis, biopsy Decipher remained a significant predictor of metastasis (hazard ratio: 1.37 per 10% increase in score, 95% confidence interval [CI]: 1.06-1.78, p=0.018) after adjusting for clinical variables. For predicting metastasis 5-yr post-biopsy, Cancer of the Prostate Risk Assessment score had a c-index of 0.60 (95% CI: 0.50-0.69), while Cancer of the Prostate Risk Assessment plus biopsy Decipher had a c-index of 0.71 (95% CI: 0.60-0.82). National Comprehensive Cancer Network risk group had a c-index of 0.66 (95% CI: 0.53-0.77), while National Comprehensive Cancer Network plus biopsy Decipher had a c-index of 0.74 (95% CI: 0.66-0.82). Biopsy Decipher was a significant predictor of PCSM (hazard ratio: 1.57 per 10% increase in score, 95% CI: 1.03-2.48, p=0.037), with a 5-yr PCSM rate of 0%, 0%, and 9.4% for Decipher low, intermediate, and high, respectively.

CONCLUSIONS:

Biopsy Decipher predicted metastasis and PCSM from diagnostic biopsy specimens of primarily intermediate- and high-risk men treated with first-line RT or RP.