Hu Jonathan C, Tosoian Jeffrey J, Qi Ji, Kaye Deborah, Johnson Anna, Linsell Susan, Montie James E, Ghani Khurshid R, Miller David C, Wojno Kirk, Burks Frank N, Spratt Daniel E, Morgan Todd M
Oakland University William Beaumont School of Medicine, Rochester.
University of Michigan, Ann Arbor.
JCO Precis Oncol. 2018;2. doi: 10.1200/po.18.00163. Epub 2018 Oct 19.
Tissue-based gene expression classifiers (GECs) may assist with management decisions in patients with newly diagnosed prostate cancer. We sought to assess the current use of GEC tests and determine how the test results are associated with primary disease management.
In this observational study, patients diagnosed with localized prostate cancer were tracked through the Michigan Urological Surgery Improvement Collaborative registry. The utilization and results of three GECs (Decipher Prostate Biopsy, Oncotype DX Prostate, and Prolaris) were prospectively collected. Practice patterns, predictors of GEC use, and effect of GEC results on disease management were investigated.
Of 3,966 newly diagnosed patients, 747 (18.8%) underwent GEC testing. The rate of GEC use in individual practices ranged from 0% to 93%, and patients undergoing GEC testing were more likely to have a lower prostate-specific antigen level, lower Gleason score, lower clinical T stage, and fewer positive cores (all < .05). Among patients with clinical favorable risk of cancer, the rate of active surveillance (AS) differed significantly among patients with a GEC result above the threshold (46.2%), those with a GEC result below the threshold (75.9%), and those who did not undergo GEC (57.9%; < .001 for comparison of the three groups). This results in an estimate that, for every nine men with favorable risk of cancer who undergo GEC testing, one additional patient may have their disease initially managed with AS. On multivariable analysis, patients with favorable-risk prostate cancer who were classified as GEC low risk were more likely to be managed on AS than those without testing (odds ratio, 1.84; = .006).
There is large variability in practice-level use and GEC tests ordered in patients with newly diagnosed, localized prostate cancer. In patients with clinical favorable risk of cancer, GEC testing significantly increased the use of AS. Additional follow-up will help determine whether incorporation of GEC testing into initial patient care favorably affects clinical outcomes.
基于组织的基因表达分类器（GEC）可能有助于新诊断前列腺癌患者的管理决策。我们试图评估GEC检测的当前使用情况，并确定检测结果与原发性疾病管理的关联方式。
在这项观察性研究中，通过密歇根泌尿外科手术改进协作登记处追踪诊断为局限性前列腺癌的患者。前瞻性收集了三种GEC（Decipher前列腺活检、Oncotype DX前列腺和Prolaris）的使用情况和结果。研究了实践模式、GEC使用的预测因素以及GEC结果对疾病管理的影响。
在3966例新诊断患者中，747例（18.8%）接受了GEC检测。各医疗机构的GEC使用率在0%至93%之间，接受GEC检测的患者更有可能具有较低的前列腺特异性抗原水平、较低的Gleason评分、较低的临床T分期以及较少的阳性核心（均P<0.05）。在癌症临床风险较低的患者中，GEC结果高于阈值者（46.2%）、低于阈值者（75.9%）以及未接受GEC检测者（57.9%）的主动监测（AS）率存在显著差异（三组比较P<0.001）。由此估计，每9例接受GEC检测的癌症低风险男性中，可能会有1例患者最初采用AS管理其疾病。多变量分析显示，被分类为GEC低风险的癌症低风险前列腺癌患者比未进行检测的患者更有可能采用AS管理（比值比，1.84；P=0.006）。
新诊断的局限性前列腺癌患者在实践层面的使用情况和所开具的GEC检测存在很大差异。在癌症临床风险较低的患者中，GEC检测显著增加了AS的使用。进一步的随访将有助于确定将GEC检测纳入初始患者护理是否会对临床结果产生有利影响。
