Department of Surgery, Durham VA Medical Center, Durham, North Carolina, USA.
Int J Radiat Oncol Biol Phys. 2013 Aug 1;86(5):848-53. doi: 10.1016/j.ijrobp.2013.04.043. Epub 2013 Jun 5.
To evaluate the prognostic utility of the cell cycle progression (CCP) score, a RNA signature based on the average expression level of 31 CCP genes, for predicting biochemical recurrence (BCR) in men with prostate cancer treated with external beam radiation therapy (EBRT) as their primary curative therapy.
The CCP score was derived retrospectively from diagnostic biopsy specimens of men diagnosed with prostate cancer from 1991 to 2006 (n=141). All patients were treated with definitive EBRT; approximately half of the cohort was African American. Outcome was time from EBRT to BCR using the Phoenix definition. Median follow-up for patients without BCR was 4.8 years. Association with outcome was evaluated by Cox proportional hazards survival analysis and likelihood ratio tests.
Of 141 patients, 19 (13%) had BCR. The median CCP score for patient samples was 0.12. In univariable analysis, CCP score significantly predicted BCR (P=.0017). The hazard ratio for BCR was 2.55 for 1-unit increase in CCP score (equivalent to a doubling of gene expression). In a multivariable analysis that included Gleason score, prostate-specific antigen, percent positive cores, and androgen deprivation therapy, the hazard ratio for CCP changed only marginally and remained significant (P=.034), indicating that CCP provides prognostic information that is not provided by standard clinical parameters. With 10-year censoring, the CCP score was associated with prostate cancer-specific mortality (P=.013). There was no evidence for interaction between CCP and any clinical variable, including ethnicity.
Among men treated with EBRT, the CCP score significantly predicted outcome and provided greater prognostic information than was available with clinical parameters. If validated in a larger cohort, CCP score could identify high-risk men undergoing EBRT who may need more aggressive therapy.
评估细胞周期进展(CCP)评分的预后效用,该评分是一种基于 31 个 CCP 基因平均表达水平的 RNA 标志物,用于预测接受外束放射治疗(EBRT)作为主要治疗的前列腺癌男性的生化复发(BCR)。
CCP 评分是从 1991 年至 2006 年诊断为前列腺癌的男性的诊断性活检标本中回顾性得出的(n=141)。所有患者均接受根治性 EBRT 治疗;队列的一半左右为非裔美国人。使用凤凰定义的 BCR 从 EBRT 到 BCR 的时间是通过 Cox 比例风险生存分析和似然比检验来评估与结果的关联。
在 141 名患者中,19 名(13%)发生了 BCR。患者样本的中位 CCP 评分为 0.12。在单变量分析中,CCP 评分显著预测了 BCR(P=.0017)。CCP 评分增加 1 个单位时,BCR 的危险比为 2.55(相当于基因表达的两倍)。在包括 Gleason 评分、前列腺特异性抗原、阳性核心百分比和雄激素剥夺治疗的多变量分析中,CCP 的危险比仅略有变化且仍然显著(P=.034),这表明 CCP 提供了标准临床参数无法提供的预后信息。在 10 年截止时,CCP 评分与前列腺癌特异性死亡率相关(P=.013)。CCP 与任何临床变量(包括种族)之间没有交互作用的证据。
在接受 EBRT 治疗的男性中,CCP 评分显著预测了结局,并提供了比临床参数更具预后意义的信息。如果在更大的队列中得到验证,CCP 评分可以识别接受 EBRT 的高危男性,他们可能需要更积极的治疗。