A Genomic Classifier Improves Prediction of Metastatic Disease Within 5 Years After Surgery in Node-negative High-risk Prostate Cancer Patients Managed by Radical Prostatectomy Without Adjuvant Therapy

摘要: Abstract Background Surgery is a standard first-line therapy for men with intermediate- or high-risk prostate cancer. Clinical factors such as tumor grade, stage, and prostate-specific antigen (PSA) are currently used to identify those who at risk of recurrence may benefit from adjuvant therapy, but novel biomarkers that improve stratification distinguish local systemic needed. Objective To determine whether adding the Decipher genomic classifier, validated metastasis risk–prediction model, risk-stratification tools (CAPRA-S Stephenson nomogram) improves accuracy in predicting metastatic disease within 5 yr after surgery (rapid [RM]) an independent cohort adverse pathologic features radical prostatectomy (RP). Design, setting, participants The study population consisted 169 patients selected 2641 underwent RP Cleveland Clinic between 1987 2008 met following criteria: (1) preoperative PSA >20 ng/ml, stage pT3 margin positive, Gleason score ≥8; (2) node negative; (3) undetectable post-RP PSA; (4) no neoadjuvant therapy; (5) minimum 5-yr follow-up controls. final 15 RM 154 non-RM Outcome measurements statistical analysis performance was evaluated individually combination clinical using concordance index (c-index), decision curve analysis, logistic regression prediction RM. Results limitations developed median 2.3 (interquartile range: 1.7–3.3). In multivariable significant predictor (odds ratio: 1.48; p =0.018) adjusting factors. had highest c-index, 0.77, compared model (c-index: 0.75) CAPRA-S 0.72) well panel previously reported cancer unrelated Decipher. Integration into nomogram increased c-index 0.75 (95% confidence interval [CI], 0.65–0.85) 0.79 CI, 0.68–0.89). Conclusions independently signature treated managed conservatively without any therapy. nomograms allow identification most progression should be considered multimodal inclusion trials. Patient summary Use addition information more accurately identified surgery. results suggest allows improved consider secondary among majority