Evaluating 4Kscore's role in predicting progression on active surveillance for prostate cancer independently of clinical information and PIRADS score.

IF 5.1 2区 医学 Q1 ONCOLOGY Prostate Cancer and Prostatic Diseases Pub Date : 2024-09-27 DOI:10.1038/s41391-024-00898-w
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
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Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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评估 4Kscore 在独立于临床信息和 PIRADS 评分预测前列腺癌主动监测进展方面的作用。
背景:4Kscore 用于帮助决定是否进行前列腺活检,但它在主动监测(AS)中的作用尚未在基于磁共振成像(MRI)的方案中得到研究。我们的目的是评估在基于磁共振成像的前瞻性方案中接受主动监测的男性中,4K评分与病情进展之间的关联:这是一项单机构、单臂、非治疗性的介入试验,在 2014-2020 年间招募了 166 名经活检确诊的前列腺癌男性患者。患者被纳入试验规定的AS方案,包括每年一次的多参数(mp)磁共振成像、前列腺活检和诊断后48个月的4K评分随访。我们分析了确诊活检和后续监测活检的方案定义和分级进展:结果:在 166 名患者中,83 名(50%)患者按方案进展,其中 41 名(占整个组群的 24.7%)患者按等级进展。在确诊活检时,基线 4K 评分≥ 20% 的男性与 4K 评分较低的男性相比,等级进展的风险更高:对于接受强直性脊柱炎治疗的患者,基线4K评分可预测确诊活检时的分级进展,最近的4K评分可预测监测活检时的按方案分级进展。
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来源期刊
Prostate Cancer and Prostatic Diseases
Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学
CiteScore
10.00
自引率
6.20%
发文量
142
审稿时长
6-12 weeks
期刊介绍: Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
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