Martin Darryl T, Ghabili Kamyar, Levi Angelique, Humphrey Peter A, Sprenkle Preston C
Department of Urology, Yale School of Medicine, New Haven, CT.
Department of Pathology, Yale School of Medicine, New Haven, CT.
Urology. 2019 Mar;125:64-72. doi: 10.1016/j.urology.2018.12.001. Epub 2018 Dec 12.
To assess the association between Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) score, the Decipher score, and histologic grade of carcinoma in biopsy tissue among low- to intermediate-risk prostate cancer patients.
MRI-ultrasound targeted biopsy of regions of interest and concurrent 12-core systematic biopsy was performed on men with Gleason grade group (GG) 1 and 2. We compared Decipher score with PI-RADS scores and biopsy Gleason GG. Subgroup analyses were performed to evaluate patients who underwent radical prostatectomy (RP), and men with Decipher testing from a targeted biopsy core.
One hundred two patients with GG1 and GG2 had biopsy Decipher testing. There was no significant difference in the median Decipher scores among the 3 multiparametric magnetic resonance imaging categories. Patients with GG2 vs GG1 in the setting of PI-RADS 4-5 had higher genomic scores (P = .01), but no significant difference was noted in patients with PI-RADS ≤3. The rate of genomic higher-risk disease on a targeted biopsy from PI-RADS5 was higher in GG2 (75%) vs GG1 (11.1%; P = .01). On multivariable logistic regression analysis, the Decipher score ≥0.45, (odds ratio (OR) 2.71; P = .02), and age (OR 1.11; P = .004) remained significant factors associated with Gleason GG2 on biopsy.
High-risk genomic classification can be seen across all combinations of PI-RADS categories and Gleason GG1 and GG2, confirming a potential utility for Decipher testing in men with low- to favorable intermediate-risk prostate cancer. The Decipher biopsy genomic test related to Gleason GG independent of PI-RADSv2 score. Confirmatory genomic testing for patients undergoing active surveillance appears more valuable than PI-RADSv2 score.
评估低至中危前列腺癌患者活检组织中前列腺影像报告和数据系统第2版（PI-RADSv2）评分、Decipher评分与癌组织学分级之间的关联。
对Gleason分级组（GG）为1和2级的男性患者进行磁共振成像-超声靶向活检感兴趣区域，并同时进行12针系统活检。我们比较了Decipher评分与PI-RADS评分以及活检Gleason GG。进行亚组分析以评估接受根治性前列腺切除术（RP）的患者，以及来自靶向活检核心的进行Decipher检测的男性患者。
102例GG1和GG2级患者进行了活检Decipher检测。在3种多参数磁共振成像类别中，中位Decipher评分无显著差异。在PI-RADS 4 - 5的情况下，GG2级患者与GG1级患者相比，基因组评分更高（P = 0.01），但在PI-RADS≤3的患者中未观察到显著差异。PI-RADS5靶向活检中基因组高风险疾病的发生率在GG2级患者中为75%，而在GG1级患者中为11.1%（P = 0.01）。在多变量逻辑回归分析中，Decipher评分≥0.45（比值比（OR）2.71；P = 0.02）和年龄（OR 1.11；P = 0.004）仍然是活检时与Gleason GG≥2相关的显著因素。
在PI-RADS类别以及Gleason GG1和GG2的所有组合中均可发现高风险基因组分类，证实了Decipher检测在低至中危前列腺癌男性患者中的潜在应用价值。Decipher活检基因组检测与Gleason GG相关，独立于PI-RADSv2评分。对于接受主动监测的患者，验证性基因组检测似乎比PI-RADSv2评分更有价值。
