提高诊断为前列腺癌的退伍军人的风险分层：17 基因前列腺评分检测的影响。
Improving risk stratification among veterans diagnosed with prostate cancer: impact of the 17-gene prostate score assay.
机构信息
Bedford VA Medical Center; 200 Springs Road; Bedford, MA 01730. E-mail:
出版信息
Am J Manag Care. 2018 Jan;24(1 Suppl):S4-S10.
BACKGROUND
Active surveillance (AS) has been widely implemented within Veterans Affairs' medical centers (VAMCs) as a standard of care for low-risk prostate cancer (PCa). Patient characteristics such as age, race, and Agent Orange (AO) exposure may influence advisability of AS in veterans. The 17-gene assay may improve risk stratification and management selection.
OBJECTIVES
To compare management strategies for PCa at 6 VAMCs before and after introduction of the Oncotype DX Genomic Prostate Score (GPS) assay.
STUDY DESIGN
We reviewed records of patients diagnosed with PCa between 2013 and 2014 to identify management patterns in an untested cohort. From 2015 to 2016, these patients received GPS testing in a prospective study. Charts from 6 months post biopsy were reviewed for both cohorts to compare management received in the untested and tested cohorts.
SUBJECTS
Men who just received their diagnosis and have National Comprehensive Cancer Network (NCCN) very low-, low-, and select cases of intermediate-risk PCa.
RESULTS
Patient characteristics were generally similar in the untested and tested cohorts. AS utilization was 12% higher in the tested cohort compared with the untested cohort. In men younger than 60 years, utilization of AS in tested men was 33% higher than in untested men. AS in tested men was higher across all NCCN risk groups and races, particular in low-risk men (72% vs 90% for untested vs tested, respectively). Tested veterans exposed to AO received less AS than untested veterans. Tested nonexposed veterans received 19% more AS than untested veterans. Median GPS results did not significantly differ as a factor of race or AO exposure.
CONCLUSIONS
Men who receive GPS testing are more likely to utilize AS within the year post diagnosis, regardless of age, race, and NCCN risk group. Median GPS was similar across racial groups and AO exposure groups, suggesting similar biology across these groups. The GPS assay may be a useful tool to refine risk assessment of PCa and increase rates of AS among clinically and biologically low-risk patients, which is in line with guideline-based care.
背景
主动监测（AS）已在退伍军人事务部医疗中心（VAMC）广泛实施，作为低危前列腺癌（PCa）的标准治疗方法。患者的年龄、种族和接触 Agent Orange（AO）等特征可能会影响退伍军人接受 AS 的适宜性。17 基因检测可能会改善风险分层和管理选择。
目的
比较 6 家退伍军人事务部医疗中心在引入 Oncotype DX 基因组前列腺评分（GPS）检测前后，PCa 的管理策略。
研究设计
我们回顾了 2013 年至 2014 年间诊断为 PCa 的患者的记录，以确定未经测试队列中的管理模式。2015 年至 2016 年，这些患者在一项前瞻性研究中接受了 GPS 检测。对两个队列的活检后 6 个月的图表进行了回顾，以比较未经测试和测试队列中接受的管理。
受试者
仅接受诊断且符合国家综合癌症网络（NCCN）非常低、低和选择性中间风险 PCa 标准的男性。
结果
未经测试和测试队列的患者特征总体相似。与未经测试的队列相比，测试队列的 AS 使用率高 12%。在年龄小于 60 岁的男性中，接受测试的男性 AS 使用率比未接受测试的男性高 33%。在所有 NCCN 风险组和种族中，接受测试的男性 AS 使用率均较高，特别是在低危男性中（分别为未接受测试的男性 72%和测试的男性 90%）。暴露于 AO 的测试退伍军人接受的 AS 比未暴露于 AO 的退伍军人少。未暴露于 AO 的测试退伍军人接受的 AS 比未暴露于 AO 的退伍军人多 19%。中位 GPS 结果在种族或 AO 暴露因素方面无显著差异。
结论
接受 GPS 检测的男性在诊断后一年内更有可能接受 AS，无论年龄、种族和 NCCN 风险组如何。GPS 检测结果在种族和 AO 暴露组之间相似，表明这些组之间存在相似的生物学特性。GPS 检测可能是一种有用的工具，可以改善 PCa 的风险评估，并增加临床和生物学低危患者的 AS 率，这符合基于指南的治疗方法。
Zotero 插件