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Assessing the Clinical Utility of Published Prostate Cancer Polygenic Risk Scores in a Large Biobank Data Set. 在大型生物库数据集中评估已发布的前列腺癌多基因风险评分的临床实用性。
IF 8.2 1区 医学 Q1 Medicine Pub Date : 2024-05-10 DOI: 10.1016/j.euo.2024.04.017
Randy A Vince, Helen Sun, Udit Singhal, Fredrick R Schumacher, Erika Trapl, Johnie Rose, Jennifer Cullen, Nicholas Zaorsky, Johnathan Shoag, Holly Hartman, Angela Y Jia, Daniel E Spratt, Lars G Fritsche, Todd M Morgan

Background and objective: Polygenic risk scores (PRSs) have been developed to identify men with the highest risk of prostate cancer. Our aim was to compare the performance of 16 PRSs in identifying men at risk of developing prostate cancer and then to evaluate the performance of the top-performing PRSs in differentiating individuals at risk of aggressive prostate cancer.

Methods: For this case-control study we downloaded 16 published PRSs from the Polygenic Score Catalog on May 28, 2021 and applied them to Michigan Genomics Initiative (MGI) patients. Cases were matched to the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry to obtain granular clinical and pathological data. MGI prospectively enrolls patients undergoing surgery at the University of Michigan, and MUSIC is a multi-institutional registry that prospectively tracks demographic, treatment, and clinical variables. The predictive performance of each PRS was evaluated using the area under the covariate-adjusted receiver operating characteristic curve (aAUC), and the association between PRS and disease aggressiveness according to prostate biopsy data was measured using logistic regression.

Key findings and limitations: We included 18 050 patients in the analysis, of whom 15 310 were control subjects and 2740 were prostate cancer cases. The median age was 66.1 yr (interquartile range 59.9-71.6) for cases and 56.6 yr (interquartile range 42.6-66.7) for control subjects. The PRS performance in predicting the risk of developing prostate cancer according to aAUC ranged from 0.51 (95% confidence interval 0.51-0.53) to 0.67 (95% confidence interval 0.66-0.68). By contrast, there was no association between PRS and disease aggressiveness.

Conclusions and clinical implications: Prostate cancer PRSs have modest real-world performance in identifying patients at higher risk of developing prostate cancer; however, they are limited in distinguishing patients with indolent versus aggressive disease.

Patient summary: Risk scores using data for multiple genes (called polygenic risk scores) can identify men at higher risk of developing prostate cancer. However, these scores need to be refined to be able to identify men with the highest risk for clinically significant prostate cancer.

背景和目的:多基因风险评分(PRSs)被用来识别罹患前列腺癌风险最高的男性。我们的目的是比较 16 个多基因风险评分在识别前列腺癌高危男性方面的表现,然后评估表现最好的多基因风险评分在区分侵袭性前列腺癌高危个体方面的表现:在这项病例对照研究中,我们于 2021 年 5 月 28 日从多基因评分目录(Polygenic Score Catalog)中下载了 16 个已发布的 PRS,并将它们应用于密歇根基因组学倡议(Michigan Genomics Initiative,MGI)患者。病例与密歇根州泌尿外科手术改进协作组(MUSIC)登记处进行匹配,以获得详细的临床和病理数据。MGI 对在密歇根大学接受手术的患者进行前瞻性登记,而 MUSIC 是一个多机构登记系统,对人口统计学、治疗和临床变量进行前瞻性跟踪。我们使用协变量调整后接收者操作特征曲线下面积(aAUC)评估了每个前列腺特异性指标的预测性能,并根据前列腺活检数据使用逻辑回归测量了前列腺特异性指标与疾病侵袭性之间的关联:我们在分析中纳入了 18 050 名患者,其中 15 310 人为对照组,2740 人为前列腺癌病例。病例的中位年龄为 66.1 岁(四分位数间距为 59.9-71.6),对照组的中位年龄为 56.6 岁(四分位数间距为 42.6-66.7)。根据aAUC,PRS在预测前列腺癌发病风险方面的表现介于0.51(95%置信区间0.51-0.53)和0.67(95%置信区间0.66-0.68)之间。相比之下,PRS与疾病侵袭性之间没有关联:前列腺癌PRS在识别前列腺癌高风险患者方面具有适度的现实表现;但是,它们在区分疾病的隐匿性和侵袭性方面存在局限性:使用多基因数据的风险评分(称为多基因风险评分)可以识别罹患前列腺癌风险较高的男性。然而,这些评分还需要进一步完善,以便能够识别出临床上罹患前列腺癌风险最高的男性。
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引用次数: 0
Contemporary Diagnosis of Very Low-risk Prostate Cancer in a Multihospital Health Care System. 多医院医疗保健系统对极低风险前列腺癌的当代诊断。
IF 8.2 1区 医学 Q1 Medicine Pub Date : 2024-05-10 DOI: 10.1016/j.euo.2024.04.015
Richard Bennett, Eric V Li, Austin Y Ho, Jonathan Aguiar, Ashorne K Mahenthiran, Chalairat Suk-Ouichai, Sai K Kumar, Clayton Neill, Edward M Schaeffer, Anugayathri Jawahar, Hiten D Patel, Ashley E Ross

The National Comprehensive Cancer Network (NCCN) very low risk (VLR) category for prostate cancer (PCa) represents clinically insignificant disease, and detection of VLR PCa contributes to overdiagnosis. Greater use of magnetic resonance imaging (MRI) and biomarkers before patient selection for prostate biopsy (PBx) reduces unnecessary biopsies and may reduce the diagnosis of clinically insignificant PCa. We tested a hypothesis that the proportion of VLR diagnoses has decreased with greater use of MRI-informed PBx using data from our 11-hospital system. From 2018 to 2023, 351/3197 (11%) men diagnosed with PCa met the NCCN VLR criteria. The proportion of VLR diagnoses did not change from 2018 to 2023 (p = 0.8) despite an increase in the use of MRI-informed PBx (from 49% to 82%; p < 0.001). Of patients who underwent combined systematic and targeted PBx and were diagnosed with VLR disease, cancer was found in systematic PBx regions in 79% of cases and in targeted PBx regions in 31% of cases. When performing both systematic and targeted PBx, prebiopsy MRI-based risk calculators could limit VLR diagnosis by 41% using a risk threshold of >5% for Gleason grade group ≥3 PCa to recommend biopsy; the reduction would be 77% if performing targeted PBx only. These findings suggest that VLR disease continues to account for a significant minority of PCa diagnoses and could be limited by targeted PBx and risk stratification calculators. PATIENT SUMMARY: We looked at recent trends for the diagnosis of very low-risk (VLR) prostate cancer. We found that VLR cancer still seems to be frequently diagnosed despite the use of MRI (magnetic resonance imaging) scans before biopsy. The use of risk calculators to identify men who could avoid biopsy and/or biopsy only for lesions that are visible on MRI could reduce the overdiagnosis of VLR prostate cancer.

美国国立综合癌症网络(NCCN)的前列腺癌(PCa)极低风险(VLR)类别代表了临床意义不大的疾病,而检测出 VLR PCa 会导致过度诊断。在选择患者进行前列腺活检(PBx)前更多地使用磁共振成像(MRI)和生物标志物可减少不必要的活检,并可减少对临床症状不明显的 PCa 的诊断。我们利用 11 家医院系统的数据检验了一个假设,即随着 MRI-informed PBx 的更广泛使用,VLR 诊断的比例有所下降。从 2018 年到 2023 年,351/3197(11%)名确诊为 PCa 的男性符合 NCCN VLR 标准。从2018年到2023年,VLR诊断的比例没有变化(p = 0.8),尽管MRI-informed PBx的使用增加了(从49%增加到82%;P 5%为Gleason分级组≥3的PCa建议活检;如果只进行靶向PBx,则减少77%)。这些研究结果表明,在 PCa 诊断中,VLR 疾病仍占相当大的比例,而有针对性的 PBx 和风险分层计算器可以限制 VLR 疾病的发生。患者摘要:我们研究了极低风险(VLR)前列腺癌诊断的最新趋势。我们发现,尽管在活检前使用了 MRI(磁共振成像)扫描,但 VLR 癌症似乎仍经常被诊断出来。使用风险计算器来确定哪些男性可以避免活检和/或只对核磁共振成像可见病灶进行活检,可以减少VLR前列腺癌的过度诊断。
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引用次数: 0
Biochemical Response of <0.1 ng/ml Predicts Therapy-free Survival of Prostate Cancer Patients following Prostate-specific Membrane Antigen-targeted Salvage Surgery. 生化反应<0.1纳克/毫升可预测前列腺癌患者接受前列腺特异性膜抗原靶向挽救手术后的无治疗生存期
IF 8.2 1区 医学 Q1 Medicine Pub Date : 2024-05-09 DOI: 10.1016/j.euo.2024.04.019
Sophie Knipper, Flemming Lischewski, Daniel Koehler, Matthias Eiber, Fijs W B van Leeuwen, Hilda de Barros, Anne-Claire Berrens, Lotte Zuur, Pim J van Leeuwen, Henk van der Poel, Francesca Ambrosini, Fabian Falkenbach, Lars Budäus, Thomas Steuber, Markus Graefen, Pierre Tennstedt, Jürgen E Gschwend, Thomas Horn, Matthias M Heck, Tobias Maurer

Background: In a subset of patients with oligorecurrent prostate cancer (PCa), salvage surgery with prostate-specific membrane antigen (PSMA) radioguided surgery (PSMA-RGS) seems to be of value.

Objective: To evaluate whether a lower level of postoperative prostate-specific antigen (PSA; <0.1 ng/ml) is predictive of therapy-free survival (TFS) following salvage PSMA-RGS.

Design, setting, and participants: This cohort study evaluated patients with biochemical recurrence after radical prostatectomy and oligorecurrent PCa on PSMA positron emission tomography treated with PSMA-RGS in three tertiary care centers (2014-2022).

Intervention: PSMA-RGS.

Outcome measurements and statistical analysis: Postsalvage surgery PSA response was categorized as <0.1, 0.1-<0.2, or >0.2 ng/ml. Kaplan-Meier and multivariable Cox regression models evaluated TFS according to PSA response.

Results and limitations: Among 553 patients assessed, 522 (94%) had metastatic soft tissue lesions removed during PSMA-RGS. At 2-16 wk after PSMA-RGS, 192, 62, and 190 patients achieved PSA levels of <0.1, 0.1-<0.2, and >0.2 ng/ml, respectively. At 2 yr of follow-up, TFS rate was 81.1% versus 56.1% versus 43.1% (p < 0.001) for patients with PSA <0.1 versus 0.1-<0.2 versus >0.2 ng/ml. In multivariable analyses, PSA levels of 0.1-0.2 ng/ml (hazard ratio [HR]: 1.9, confidence interval [CI]: 1.1-3.1) and ≥0.2 ng/ml (HR: 3.2, CI: 2.2-4.6, p < 0.001) independently predicted the need for additional therapy after PSMA-RGS. The main limitation is the lack of a control group.

Conclusions: For patients after salvage PSMA-RGS, a lower biochemical response (PSA <0.1 ng/ml) seems to predict longer TFS. This insight may help in counseling patients postoperatively as well as guiding the timely selection of additional therapy.

Patient summary: We studied what happened to prostate cancer patients in three European centers who had salvage surgery using a special method called prostate-specific membrane antigen-targeted radioguidance. We found that patients who had low prostate-specific antigen levels soon after surgery were less likely to need further treatment for a longer time.

背景:在部分少复发前列腺癌(PCa)患者中,使用前列腺特异性膜抗原(PSMA)放射引导手术(PSMA-RGS)进行挽救性手术似乎很有价值:评估术后前列腺特异性抗原(PSA)水平是否较低:这项队列研究评估了在三个三级医疗中心接受PSMA-RGS治疗(2014-2022年)的根治性前列腺切除术后生化复发且PSMA正电子发射断层扫描显示为寡发PCa的患者:结果测量和统计分析:手术后PSA反应为0.2纳克/毫升。Kaplan-Meier和多变量Cox回归模型根据PSA反应评估TFS:在接受评估的 553 例患者中,有 522 例(94%)在 PSMA-RGS 期间切除了转移性软组织病灶。PSMA-RGS 术后 2-16 周,分别有 192、62 和 190 例患者的 PSA 水平达到 0.2 ng/ml。随访 2 年后,TFS 率分别为 81.1%、56.1% 和 43.1%(P 0.2 ng/ml)。在多变量分析中,PSA水平为0.1-0.2纳克/毫升(危险比[HR]:1.9,置信区间[CI]:1.1-3.1)和≥0.2纳克/毫升(HR:3.2,CI:2.2-4.6,P 结论:PSA水平为0.1-0.2纳克/毫升的患者,TFS率为81.1%对56.1%对43.1%:对于接受 PSMA-RGS 挽救手术的患者,生化反应(PSA)较低 患者摘要:我们研究了欧洲三家中心的前列腺癌患者采用前列腺特异性膜抗原靶向放射引导这一特殊方法进行挽救手术的情况。我们发现,术后不久前列腺特异性抗原水平较低的患者较少需要长期接受进一步治疗。
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引用次数: 0
Prognostic and Predictive Role of SPOP Mutations in Prostate Cancer: A Systematic Review and Meta-analysis. 前列腺癌 SPOP 基因突变的预后和预测作用:系统回顾与元分析》。
IF 8.2 1区 医学 Q1 Medicine Pub Date : 2024-05-03 DOI: 10.1016/j.euo.2024.04.011
Martino Pedrani, Giuseppe Salfi, Sara Merler, Irene Testi, Massimiliano Cani, Fabio Turco, Elena Trevisi, Luigi Tortola, Giorgio Treglia, Gian Luca Di Tanna, Ursula Vogl, Silke Gillessen, Jean-Philippe Theurillat, Ricardo Pereira Mestre

Context: Mutations in the speckle-type POZ (SPOP) gene are frequently identified in prostate cancer (PC); yet, prognostic implications for affected patients remain unclear. Limited consensus exists regarding tailored treatments for SPOP-mutant (SPOPmut) PC.

Objective: To elucidate the prognostic and predictive significance of SPOP mutations across distinct PC stages and treatments.

Evidence acquisition: A systematic literature search of PubMed, Embase, and Scopus was conducted up to January 29, 2024. The meta-analysis included studies comparing survival outcomes between SPOPmut and SPOP wild-type (SPOPwt) PC.

Evidence synthesis: From 669 records, 26 studies (including five abstracts) were analyzed. A meta-analysis of metastasis-free survival in localized (hazard ratio [HR]: 0.72, 95% confidence interval [CI]: 0.59-0.88; p < 0.01) and overall survival (OS) in metastatic PC (HR: 0.64, 95% CI: 0.53-0.76; p < 0.01) showed a favorable prognosis for patients with SPOPmut PC. In metastatic settings, SPOP mutations correlated with improved progression-free survival (PFS) and OS in patients undergoing androgen deprivation therapy ± androgen receptor signaling inhibitor (HR: 0.51, 95% CI: 0.35-0.76, p < 0.01, and HR: 0.60, 95% CI:0.46-0.79, p < 0.01, respectively). In metastatic castration-resistant PC, only abiraterone provided improved PFS and OS to patients with SPOP mutations compared with patients with SPOPwt, but data were limited. SPOP mutations did not correlate with improved PFS (p = 0.80) or OS (p = 0.27) for docetaxel.

Conclusions: Patients with SPOPmut PC seem to exhibit superior oncological outcomes compared with patients with SPOPwt. Tailored risk stratification and treatment approaches should be explored in such patients.

Patient summary: Speckle-type POZ (SPOP) mutations could be a favorable prognostic factor in patients with prostate cancer (PC) and may also predict better progression-free and overall survival than treatment with hormonal agents. Therefore, less intensified treatments omitting chemotherapy for patients with SPOP-mutant PC should be explored in clinical trials.

背景:前列腺癌(PC)中经常会发现斑点型POZ(SPOP)基因突变,但对受影响患者的预后影响仍不明确。关于SPOP突变(SPOPmut)PC的定制治疗,目前达成的共识有限:目的:阐明SPOP突变在不同PC分期和治疗中的预后和预测意义:对截至 2024 年 1 月 29 日的 PubMed、Embase 和 Scopus 文献进行了系统检索。荟萃分析包括比较SPOP突变型和SPOP野生型(SPOPwt)PC生存结果的研究:对 669 条记录中的 26 项研究(包括 5 篇摘要)进行了分析。对局部无转移生存率(危险比 [HR]:0.72,95% 置信区间)进行了荟萃分析:0.72,95% 置信区间 [CI]:0.59-0.88; p 结论:与 SPOPwt 患者相比,SPOPmut PC 患者的肿瘤治疗效果似乎更好。患者总结:斑点型POZ(SPOP)突变可能是前列腺癌(PC)患者的有利预后因素,也可能预示着比激素药物治疗更好的无进展生存期和总生存期。因此,应在临床试验中探索对SPOP突变PC患者采取省略化疗的低强度治疗方法。
{"title":"Prognostic and Predictive Role of SPOP Mutations in Prostate Cancer: A Systematic Review and Meta-analysis.","authors":"Martino Pedrani, Giuseppe Salfi, Sara Merler, Irene Testi, Massimiliano Cani, Fabio Turco, Elena Trevisi, Luigi Tortola, Giorgio Treglia, Gian Luca Di Tanna, Ursula Vogl, Silke Gillessen, Jean-Philippe Theurillat, Ricardo Pereira Mestre","doi":"10.1016/j.euo.2024.04.011","DOIUrl":"https://doi.org/10.1016/j.euo.2024.04.011","url":null,"abstract":"<p><strong>Context: </strong>Mutations in the speckle-type POZ (SPOP) gene are frequently identified in prostate cancer (PC); yet, prognostic implications for affected patients remain unclear. Limited consensus exists regarding tailored treatments for SPOP-mutant (SPOPmut) PC.</p><p><strong>Objective: </strong>To elucidate the prognostic and predictive significance of SPOP mutations across distinct PC stages and treatments.</p><p><strong>Evidence acquisition: </strong>A systematic literature search of PubMed, Embase, and Scopus was conducted up to January 29, 2024. The meta-analysis included studies comparing survival outcomes between SPOPmut and SPOP wild-type (SPOPwt) PC.</p><p><strong>Evidence synthesis: </strong>From 669 records, 26 studies (including five abstracts) were analyzed. A meta-analysis of metastasis-free survival in localized (hazard ratio [HR]: 0.72, 95% confidence interval [CI]: 0.59-0.88; p < 0.01) and overall survival (OS) in metastatic PC (HR: 0.64, 95% CI: 0.53-0.76; p < 0.01) showed a favorable prognosis for patients with SPOPmut PC. In metastatic settings, SPOP mutations correlated with improved progression-free survival (PFS) and OS in patients undergoing androgen deprivation therapy ± androgen receptor signaling inhibitor (HR: 0.51, 95% CI: 0.35-0.76, p < 0.01, and HR: 0.60, 95% CI:0.46-0.79, p < 0.01, respectively). In metastatic castration-resistant PC, only abiraterone provided improved PFS and OS to patients with SPOP mutations compared with patients with SPOPwt, but data were limited. SPOP mutations did not correlate with improved PFS (p = 0.80) or OS (p = 0.27) for docetaxel.</p><p><strong>Conclusions: </strong>Patients with SPOPmut PC seem to exhibit superior oncological outcomes compared with patients with SPOPwt. Tailored risk stratification and treatment approaches should be explored in such patients.</p><p><strong>Patient summary: </strong>Speckle-type POZ (SPOP) mutations could be a favorable prognostic factor in patients with prostate cancer (PC) and may also predict better progression-free and overall survival than treatment with hormonal agents. Therefore, less intensified treatments omitting chemotherapy for patients with SPOP-mutant PC should be explored in clinical trials.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association Between GLP1R Agonists and Prostate, Kidney, and Bladder Cancers. GLP1R 激动剂与前列腺癌、肾癌和膀胱癌之间的关系
IF 8.2 1区 医学 Q1 Medicine Pub Date : 2024-05-02 DOI: 10.1016/j.euo.2024.04.006
Laura Bukavina, Emma Helstrom, Christopher J D Wallis, Antoniy Fulmes, Adam Calaway, Andres Correa, Stephen Rhodes
{"title":"Association Between GLP1R Agonists and Prostate, Kidney, and Bladder Cancers.","authors":"Laura Bukavina, Emma Helstrom, Christopher J D Wallis, Antoniy Fulmes, Adam Calaway, Andres Correa, Stephen Rhodes","doi":"10.1016/j.euo.2024.04.006","DOIUrl":"https://doi.org/10.1016/j.euo.2024.04.006","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Comparison of Globally Applied Prognostic Risk Groups and the Prevalence of Metastatic Disease on Prostate-specific Membrane Antigen Positron Emission Tomography in Patients with Newly Diagnosed Prostate Cancer. 新诊断前列腺癌患者的全球应用预后风险组别与前列腺特异性膜抗原正电子发射断层扫描显示的转移性疾病患病率比较。
IF 8.2 1区 医学 Q1 Medicine Pub Date : 2024-04-30 DOI: 10.1016/j.euo.2024.04.005
Wietske I Luining, Liselotte M S Boevé, Marinus J Hagens, Dennie Meijer, Tessa de Weijer, Rosemarijn H Ettema, Remco J J Knol, Ton A Roeleveld, Sandra Srbljin, Saskia Weltings, Jose C C Koppes, Reindert J A van Moorselaar, Pim J van Leeuwen, Matthijs C F Cysouw, Daniela E Oprea-Lager, André N Vis

Background: Various risk classification systems (RCSs) are used globally to stratify newly diagnosed patients with prostate cancer (PCa) into prognostic groups.

Objective: To compare the predictive value of different prognostic subgroups (low-, intermediate-, and high-risk disease) within the RCSs for detecting metastatic disease on prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) for primary staging, and to assess whether further subdivision of subgroups would be beneficial.

Design, setting, and participants: Patients with newly diagnosed PCa, in whom PSMA-PET/CT was performed between 2017 and 2022, were studied retrospectively. Patients were stratified into risk groups based on four RCSs: European Association of Urology, National Comprehensive Cancer Network (NCCN), Cambridge Prognostic Group (CPG), and Cancer of the Prostate Risk Assessment.

Outcome measurements and statistical analysis: The prevalence of metastatic disease on PSMA-PET/CT was compared among the subgroups within the four RCSs.

Results and limitations: In total, 2630 men with newly diagnosed PCa were studied. Any metastatic disease was observed in 35% (931/2630) of patients. Among patients classified as having intermediate- and high-risk disease, the prevalence of metastases ranged from approximately 12% to 46%. Two RCSs further subdivided these groups. According to the NCCN, metastatic disease was observed in 5.8%, 13%, 22%, and 62% for favorable intermediate-, unfavorable intermediate-, high-, and very-high-risk PCa, respectively. Regarding the CPG, these values were 6.9%, 13%, 21%, and 60% for the corresponding risk groups.

Conclusions: This study underlines the importance of nuanced risk stratification, recommending the further subdivision of intermediate- and high-risk disease given the notable variation in the prevalence of metastatic disease. PSMA-PET/CT for primary staging should be reserved for patients with unfavorable intermediate- or higher-risk disease.

Patient summary: The use of various risk classification systems in patients with prostate cancer helps identify those at a higher risk of having metastatic disease on prostate-specific membrane antigen positron emission tomography/computed tomography for primary staging.

背景:全球使用各种风险分类系统(RCS)对新诊断的前列腺癌(PCa)患者进行预后分层:全球使用各种风险分类系统(RCS)对新诊断的前列腺癌(PCa)患者进行预后分层:目的:比较RCS中不同预后亚组(低危、中危和高危疾病)对前列腺特异性膜抗原(PSMA)正电子发射断层扫描(PET)/计算机断层扫描(CT)原发分期检测转移性疾病的预测价值,并评估进一步细分亚组是否有益:对2017年至2022年间进行PSMA-PET/CT检查的新诊断PCa患者进行回顾性研究。根据四种RCS将患者分为不同的风险组:结果测量和统计分析:结果测量和统计分析:比较了四个预后评估组中不同亚组的 PSMA-PET/CT 转移性疾病发生率:共研究了2630名新诊断为PCa的男性患者。35%的患者(931/2630)出现了转移性疾病。在被列为中危和高危的患者中,转移率约为12%至46%。两个风险分类标准进一步细分了这些组别。根据 NCCN,中危、危、高危和极高危 PCa 的转移率分别为 5.8%、13%、22% 和 62%。至于CPG,相应风险组的数值分别为6.9%、13%、21%和60%:本研究强调了细致风险分层的重要性,鉴于转移性疾病发病率的显著差异,建议进一步细分中危和高危疾病。前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描(PSMA-PET/CT)用于原发分期时,应保留给中危或高危不利疾病患者。患者总结:在前列腺癌患者中使用各种风险分级系统有助于确定前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描用于原发分期时转移性疾病风险较高的患者。
{"title":"A Comparison of Globally Applied Prognostic Risk Groups and the Prevalence of Metastatic Disease on Prostate-specific Membrane Antigen Positron Emission Tomography in Patients with Newly Diagnosed Prostate Cancer.","authors":"Wietske I Luining, Liselotte M S Boevé, Marinus J Hagens, Dennie Meijer, Tessa de Weijer, Rosemarijn H Ettema, Remco J J Knol, Ton A Roeleveld, Sandra Srbljin, Saskia Weltings, Jose C C Koppes, Reindert J A van Moorselaar, Pim J van Leeuwen, Matthijs C F Cysouw, Daniela E Oprea-Lager, André N Vis","doi":"10.1016/j.euo.2024.04.005","DOIUrl":"https://doi.org/10.1016/j.euo.2024.04.005","url":null,"abstract":"<p><strong>Background: </strong>Various risk classification systems (RCSs) are used globally to stratify newly diagnosed patients with prostate cancer (PCa) into prognostic groups.</p><p><strong>Objective: </strong>To compare the predictive value of different prognostic subgroups (low-, intermediate-, and high-risk disease) within the RCSs for detecting metastatic disease on prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) for primary staging, and to assess whether further subdivision of subgroups would be beneficial.</p><p><strong>Design, setting, and participants: </strong>Patients with newly diagnosed PCa, in whom PSMA-PET/CT was performed between 2017 and 2022, were studied retrospectively. Patients were stratified into risk groups based on four RCSs: European Association of Urology, National Comprehensive Cancer Network (NCCN), Cambridge Prognostic Group (CPG), and Cancer of the Prostate Risk Assessment.</p><p><strong>Outcome measurements and statistical analysis: </strong>The prevalence of metastatic disease on PSMA-PET/CT was compared among the subgroups within the four RCSs.</p><p><strong>Results and limitations: </strong>In total, 2630 men with newly diagnosed PCa were studied. Any metastatic disease was observed in 35% (931/2630) of patients. Among patients classified as having intermediate- and high-risk disease, the prevalence of metastases ranged from approximately 12% to 46%. Two RCSs further subdivided these groups. According to the NCCN, metastatic disease was observed in 5.8%, 13%, 22%, and 62% for favorable intermediate-, unfavorable intermediate-, high-, and very-high-risk PCa, respectively. Regarding the CPG, these values were 6.9%, 13%, 21%, and 60% for the corresponding risk groups.</p><p><strong>Conclusions: </strong>This study underlines the importance of nuanced risk stratification, recommending the further subdivision of intermediate- and high-risk disease given the notable variation in the prevalence of metastatic disease. PSMA-PET/CT for primary staging should be reserved for patients with unfavorable intermediate- or higher-risk disease.</p><p><strong>Patient summary: </strong>The use of various risk classification systems in patients with prostate cancer helps identify those at a higher risk of having metastatic disease on prostate-specific membrane antigen positron emission tomography/computed tomography for primary staging.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endoscopic Cryoablation Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. 内镜下冷冻消融术与根治性肾切除术治疗上尿路上皮癌的比较
IF 8.2 1区 医学 Q1 Medicine Pub Date : 2024-04-30 DOI: 10.1016/j.euo.2024.04.012
Yiling Chen, Chenyang Xu, Zezhong Mou, Yun Hu, Chen Yang, Jinzhong Hu, Xinan Chen, Jianfeng Luo, Lujia Zou, Haowen Jiang

Background and objective: Cryoablation is a traditional antitumor therapy with good prospects for development. The efficacy of endoscopic management as a kidney-sparing surgery for high-risk upper tract urothelial carcinoma (UTUC) remains controversial. Our aim was to evaluate the impact of endoscopic cryoablation (ECA) versus radical nephroureterectomy (RNU) on survival outcomes, renal function, and complications.

Methods: We retrospectively analyzed data for 116 patients with newly diagnosed high-risk UTUC who underwent either ECA (n = 13) or RNU (n = 103) from March 25, 2019 to December 8, 2021. Propensity score matching (1:4) using the nearest neighbor method was performed before analysis. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), intravesical recurrence-free survival (RFS), the change in renal function, and treatment-emergent adverse events (TEAEs).

Key findings and limitations: At median follow-up of 28.2 mo for the ECA group and 27.6 mo for the RNU group, 2-yr OS (82% vs 84%), PFS (73% vs 71%), and intravesical RFS (81% vs 83%) rates after matching did not significantly differ. A decline in renal function was observed after RNU, but not after ECA. Five (41.7%) patients in the ECA group reported six TEAEs, and 17 patients (35.4%) in the RNU group reported 20 TEAEs.

Conclusions and clinical implications: In comparison to RNU, ECA for UTUC resulted in noninferior oncological outcomes and superior preservation of renal function.

Patient summary: Our study suggests that a treatment called endoscopic cryoablation for high-risk cancer in the upper urinary tract can help in preserving kidney function, with similar survival outcomes to those after more extensive surgery. This option can be considered for selected patients with a strong preference for kidney preservation.

背景和目的:冷冻消融术是一种传统的抗肿瘤疗法,具有良好的发展前景。对于高危的上尿路上皮癌(UTUC),内镜治疗作为保肾手术的疗效仍存在争议。我们的目的是评估内镜下冷冻消融术(ECA)与根治性肾切除术(RNU)对生存结果、肾功能和并发症的影响:我们回顾性分析了2019年3月25日至2021年12月8日期间接受ECA(13例)或RNU(103例)治疗的116例新确诊高危UTUC患者的数据。分析前采用近邻法进行倾向得分匹配(1:4)。主要结果是总生存期(OS)。次要结局包括无进展生存期(PFS)、无膀胱内复发生存期(RFS)、肾功能变化以及治疗突发不良事件(TEAEs):ECA组和RNU组的中位随访时间分别为28.2个月和27.6个月,匹配后的2年OS(82% vs 84%)、PFS(73% vs 71%)和膀胱内无复发生存率(81% vs 83%)无显著差异。RNU 后观察到肾功能下降,而 ECA 后没有观察到肾功能下降。ECA组有5名患者(41.7%)报告了6例TEAE,RNU组有17名患者(35.4%)报告了20例TEAE:患者总结:我们的研究表明,内镜下冷冻消融治疗上尿路高危癌症有助于保留肾功能,其生存结果与更广泛手术后的结果相似。对于选择保留肾脏的患者,可以考虑采用这种方法。
{"title":"Endoscopic Cryoablation Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma.","authors":"Yiling Chen, Chenyang Xu, Zezhong Mou, Yun Hu, Chen Yang, Jinzhong Hu, Xinan Chen, Jianfeng Luo, Lujia Zou, Haowen Jiang","doi":"10.1016/j.euo.2024.04.012","DOIUrl":"https://doi.org/10.1016/j.euo.2024.04.012","url":null,"abstract":"<p><strong>Background and objective: </strong>Cryoablation is a traditional antitumor therapy with good prospects for development. The efficacy of endoscopic management as a kidney-sparing surgery for high-risk upper tract urothelial carcinoma (UTUC) remains controversial. Our aim was to evaluate the impact of endoscopic cryoablation (ECA) versus radical nephroureterectomy (RNU) on survival outcomes, renal function, and complications.</p><p><strong>Methods: </strong>We retrospectively analyzed data for 116 patients with newly diagnosed high-risk UTUC who underwent either ECA (n = 13) or RNU (n = 103) from March 25, 2019 to December 8, 2021. Propensity score matching (1:4) using the nearest neighbor method was performed before analysis. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), intravesical recurrence-free survival (RFS), the change in renal function, and treatment-emergent adverse events (TEAEs).</p><p><strong>Key findings and limitations: </strong>At median follow-up of 28.2 mo for the ECA group and 27.6 mo for the RNU group, 2-yr OS (82% vs 84%), PFS (73% vs 71%), and intravesical RFS (81% vs 83%) rates after matching did not significantly differ. A decline in renal function was observed after RNU, but not after ECA. Five (41.7%) patients in the ECA group reported six TEAEs, and 17 patients (35.4%) in the RNU group reported 20 TEAEs.</p><p><strong>Conclusions and clinical implications: </strong>In comparison to RNU, ECA for UTUC resulted in noninferior oncological outcomes and superior preservation of renal function.</p><p><strong>Patient summary: </strong>Our study suggests that a treatment called endoscopic cryoablation for high-risk cancer in the upper urinary tract can help in preserving kidney function, with similar survival outcomes to those after more extensive surgery. This option can be considered for selected patients with a strong preference for kidney preservation.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Engaging in Clinical Research and Practice Approaches that Reduce Environmental Impact. 参与减少环境影响的临床研究和实践方法。
IF 8.2 1区 医学 Q1 Medicine Pub Date : 2024-04-29 DOI: 10.1016/j.euo.2024.04.007
Stacy Loeb

Telemedicine, virtual conferences, and reducing waste in the operating room are ways in which urologists can reduce their environmental impact in daily practice. Patient counseling should also consider advice that simultaneously promotes overall, urological, and planetary health, such as plant-based diets and active transport.

远程医疗、虚拟会议和减少手术室废物是泌尿科医生在日常工作中减少对环境影响的方法。患者咨询也应考虑同时促进整体健康、泌尿系统健康和地球健康的建议,如植物性饮食和积极的交通方式。
{"title":"Engaging in Clinical Research and Practice Approaches that Reduce Environmental Impact.","authors":"Stacy Loeb","doi":"10.1016/j.euo.2024.04.007","DOIUrl":"https://doi.org/10.1016/j.euo.2024.04.007","url":null,"abstract":"<p><p>Telemedicine, virtual conferences, and reducing waste in the operating room are ways in which urologists can reduce their environmental impact in daily practice. Patient counseling should also consider advice that simultaneously promotes overall, urological, and planetary health, such as plant-based diets and active transport.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patient-reported Quality of Life and Survival Outcomes in Prostate Cancer: Analysis of the ECOG-ACRIN E3805 Chemohormonal Androgen Ablation Randomized Trial (CHAARTED). 前列腺癌患者报告的生活质量和生存结果:ECOG-ACRIN E3805 化学激素雄激素消融随机试验 (CHAARTED) 分析。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-04-29 DOI: 10.1016/j.euo.2024.04.010
Daniel Sentana-Lledo, Xiangying Chu, David F Jarrard, Michael A Carducci, Robert S DiPaola, Lynn I Wagner, David Cella, Christopher J Sweeney, Alicia K Morgans

Background: Chemohormonal therapy with androgen deprivation therapy and docetaxel (ADT + D) improves overall survival (OS) and quality of life (QOL) at 12 mo versus androgen deprivation therapy (ADT) alone in men with metastatic hormone-sensitive prostate cancer (mHSPC). However, the prognostic role of QOL is unknown in this population.

Objective: To study the relationship between QOL, disease characteristics, and OS in men with mHSPC.

Design, setting, and participants: In this exploratory post hoc analysis, 790 patients with mHSPC completed the QOL instruments Functional Assessment of Cancer Therapy-Prostate (FACT-P), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and Brief Pain Inventory (BPI).

Outcome measurements and statistical analysis: Log-rank test and Cox proportional hazard models tested the association between QOL and OS by clinical and disease characteristics.

Results and limitations: Baseline higher FACT-P trended toward improved survival after accounting for clinical variables (hazard ratio [HR] 0.80 [0.62, 1.04], p = 0.09), while higher 3-mo FACT-P was independently associated with better survival (HR 0.76 [0.58, 1.0], p = 0.05). Patients with the poorest QOL (bottom quartile) at baseline and 3 mo had longer survival if they received ADT + D rather than ADT alone (median OS 45.2 vs 34.4 mo, HR 0.75 [0.53, 1.05], p = 0.09, and 48.3 vs 29.3 mo, HR 0.69 [0.48, 0.99], p = 0.05 respectively). In contrast, patients with the best QOL (top quartile) at baseline and 3 mo had comparable survival irrespective of whether or not docetaxel was added (median OS 72.1 vs 51.7 mo, HR 0.92 [0.63, 1.36], p = 0.69, and 69.9 vs 68.9 mo, HR 1.11 [0.73, 1.67], p = 0.63, respectively). Survival was linked with baseline FACIT-F (HR 0.76 [0.57, 1.0], p = 0.05), but not BPI (HR 0.98 [0.75, 1.28], p = 0.90).

Conclusions: Three-month QOL had a stronger independent association with survival. The most symptomatic patients had longer survival with the addition of docetaxel; conversely, the least symptomatic patients did not appear to benefit. Consideration of QOL may enhance decision-making and patient selection when choosing chemohormonal treatment in mHSPC.

Patient summary: Quality of life independently forecasted the survival of men with metastatic hormone-sensitive prostate cancer in the CHAARTED study. Close tracking of quality of life could help patients and clinicians make decisions about the appropriate treatment in this setting.

背景:在转移性激素敏感性前列腺癌(mHSPC)男性患者中,化疗激素联合雄激素剥夺疗法和多西他赛(ADT + D)与单纯雄激素剥夺疗法(ADT)相比,可提高患者12个月后的总生存期(OS)和生活质量(QOL)。然而,QOL在这一人群中的预后作用尚不清楚:研究男性转移性前列腺癌患者的 QOL、疾病特征和 OS 之间的关系:在这项探索性事后分析中,790名mHSPC患者填写了QOL工具:前列腺癌治疗功能评估(FACT-P)、慢性疾病治疗功能评估-疲劳(FACIT-F)和简明疼痛量表(BPI):结果测量和统计分析:对数秩检验和 Cox 比例危险模型按临床和疾病特征检验了 QOL 与 OS 之间的关系:在考虑临床变量后,基线较高的 FACT-P 有改善生存率的趋势(危险比 [HR] 0.80 [0.62, 1.04],P = 0.09),而较高的 3 个月 FACT-P 与较好的生存率独立相关(HR 0.76 [0.58, 1.0],P = 0.05)。基线和 3 个月时 QOL 最差(最低四分位数)的患者如果接受 ADT + D 而不是单独 ADT,则生存期更长(中位 OS 分别为 45.2 月 vs 34.4 月,HR 0.75 [0.53, 1.05],p = 0.09;48.3 月 vs 29.3 月,HR 0.69 [0.48, 0.99],p = 0.05)。相比之下,无论是否加用多西他赛,基线和3个月时QOL最好(前四分之一)的患者生存率相当(中位OS分别为72.1个月 vs 51.7个月,HR 0.92 [0.63,1.36],p = 0.69;69.9个月 vs 68.9个月,HR 1.11 [0.73,1.67],p = 0.63)。存活率与基线 FACIT-F 有关(HR 0.76 [0.57, 1.0],P = 0.05),但与 BPI 无关(HR 0.98 [0.75, 1.28],P = 0.90):结论:三个月的 QOL 与存活率有更密切的关系。症状最严重的患者在加用多西他赛后生存期更长;反之,症状最轻微的患者似乎并没有获益。在mHSPC患者选择化疗激素治疗时,对生活质量的考虑可能会促进决策和患者选择:在CHAARTED研究中,生活质量可独立预测转移性激素敏感性前列腺癌男性患者的生存期。密切跟踪生活质量有助于患者和临床医生在这种情况下做出适当治疗的决定。
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引用次数: 0
UncoVer: A Web-based Resource for Single-cell and Spatially Resolved Omics Data in Uro-oncology. UncoVer:泌尿肿瘤学单细胞和空间分辨 Omics 数据的网络资源。
IF 8.2 1区 医学 Q1 Medicine Pub Date : 2024-04-29 DOI: 10.1016/j.euo.2024.04.008
Gwendoline C V Lecuyer, Aurélie Lardenois, Frédéric Chalmel
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引用次数: 0
期刊
European urology oncology
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