Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Br J Cancer. 2020 Aug;123(4):604-609. doi: 10.1038/s41416-020-0914-7. Epub 2020 May 29.
A pre-specified model based on four kallikrein markers in blood, commercially available as 4Kscore, predicts Gleason Grade (GG) 3 + 4 or higher prostate cancer on biopsy. However, sampling error and variation in pathology reporting may miss aggressive disease.
The 4Kscore was measured in cryopreserved blood from 2330 men obtained before prostatectomy at a single institution between 2002 and 2010. Adverse surgical pathology and biochemical recurrence (BCR) were pre-specified to be assessed in all men, biopsy GG 3 + 3, and 3 + 4.
Adjusted for established clinical predictors, the 4Kscore was significantly associated with adverse pathology (OR 1.49; 95% CI 1.32, 1.67; p < 0.0001). Adding 4Kscore increased discrimination from (AUC) 0.672 to 0.718 and 0.644 to 0.659 within biopsy GG 3 + 3 and 3 + 4, respectively. Higher 4Kscore was associated with higher risk of BCR (HR 1.16, 95% CI 1.06, 1.26; p = 0.001). Adding 4Kscore improved the prediction of BCR (C-index 0.630-0.660) within GG 3 + 3, but not GG 3 + 4.
The 4Kscore can help guide the clinical decision whether additional risk assessment-such as confirmatory biopsy-is needed to decide between active surveillance versus curative therapy. Evidence that the panel could influence management in biopsy GG 3 + 4 is less strong and requires further investigation.
基于血液中四种激肽释放酶标志物的预定义模型，即商业上可获得的 4Kscore，可预测活检时的 Gleason 分级（GG）3+4 或更高的前列腺癌。然而，取样误差和病理学报告的变化可能会遗漏侵袭性疾病。
在 2002 年至 2010 年间，在一家机构中对 2330 名接受前列腺切除术的男性进行了冷冻血样中 4Kscore 的测量。在所有男性中，预先指定了不良手术病理和生化复发（BCR）来进行评估，包括活检 GG 3+3 和 3+4。
在调整了既定的临床预测因素后，4Kscore 与不良病理显著相关（OR 1.49；95%CI 1.32，1.67；p<0.0001）。在活检 GG 3+3 和 3+4 中，添加 4Kscore 分别将区分度从 AUC 0.672 提高到 0.718 和 0.644 提高到 0.659。较高的 4Kscore 与 BCR 的风险增加相关（HR 1.16，95%CI 1.06，1.26；p=0.001）。添加 4Kscore 可改善 GG 3+3 中 BCR 的预测（C 指数 0.630-0.660），但不能改善 GG 3+4 中的预测。
4Kscore 可以帮助指导临床决策，即是否需要进行额外的风险评估（如确认性活检），以决定是进行主动监测还是根治性治疗。该面板能够影响活检 GG 3+4 中管理的证据较弱，需要进一步研究。
