Tissue-based Genomics Augments Post-prostatectomy Risk Stratification in a Natural History Cohort of Intermediate- and High-Risk Men

摘要: Abstract Background Radical prostatectomy (RP) is a primary treatment option for men with intermediate- and high-risk prostate cancer. Although many are effectively cured local therapy alone, these by definition at higher risk of adverse pathologic features clinical disease recurrence. It has been shown that the Decipher test predicts metastatic progression in cohorts received adjuvant salvage following RP. Objective To evaluate genomic classifier natural history cohort who no additional until time progression. Design, setting, participants Retrospective case-cohort design 356 underwent RP between 1992 2010 intermediate or high metastasis. Participants met criteria: (1) Cancer Prostate Risk Assessment postsurgical (CAPRA-S) score ≥3; (2) Gleason ≥7; (3) post-RP prostate-specific antigen nadir Outcome measurements statistical analysis The endpoint was defined as regional distant metastases. Time-dependent receiver operating characteristic (ROC) curves, extension decision curve to survival data, univariable multivariable Cox proportional-hazards models were used measure discrimination, net benefit, prognostic potential factors. Cumulative incidence curves constructed using Fine-Gray competing-risks appropriate weighting controls account study design. Results limitations Ninety six patients had unavailable tumor blocks failed microarray quality control. scores then obtained 260 patients, whom 99 experienced correlated increased cumulative biochemical recurrence, metastasis, cancer–specific mortality ( p c -index 0.76 Eggener CAPRA-S from 0.77 0.86 0.87, respectively, 10 yr after large, single-center retrospective an important limitation. Conclusions In patient population progression, events, inclusion improved performance validated clinicopathologic models. These results confirm utility already reported Decipher. Patient summary improves identification most death cancer radical prostatectomy.