4Kscore、ExosomeDx™ 和磁共振成像在高级别前列腺癌早期检测中的临床应用
Clinical Utility of 4Kscore, ExosomeDx™ and Magnetic Resonance Imaging for the Early Detection of High Grade Prostate Cancer.
机构信息
Department of Urology, Helen Diller Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California.
Department of Urology, Humanitas Clinical and Research Center (IRCCS), Rozzano, Italy.
出版信息
J Urol. 2021 Feb;205(2):452-460. doi: 10.1097/JU.0000000000001361. Epub 2020 Sep 8.
PURPOSE
We aimed to evaluate 4Kscore and ExosomeDx™ with multiparametric magnetic resonance imaging in the detection of high grade prostate cancer and number of biopsies avoided.
MATERIAL AND METHODS
Patients had 1 liquid biomarker test with or without multiparametric magnetic resonance imaging. High grade prostate cancer was defined as Gleason grade group 2 or greater. The overall number of avoided biopsies (with Gleason grade 1 or less), and number of missed Gleason grade 2 or greater cancer among the biopsied patients, were determined.
RESULTS
Of the 783 patients in the overall cohort 419 (53.5%) underwent biopsy. 4Kscore and ExosomeDx scores higher than the manufacturers' cut point were associated with PI-RADS™ scores 3 to 5 and Gleason grade 2 or greater prostate cancer. Limiting biopsy to the men with liquid biomarker scores above the manufacturers' cut point would have resulted avoiding 29.5% to 39.9% unnecessary biopsies overall, while missing 4.0% to 4.8% Gleason grade 2 or greater prostate cancer in the biopsy group. Screening algorithms with up-front liquid biomarker testing followed by multiparametric magnetic resonance imaging if the biomarker is above the manufacturers' cut point, then followed by biopsy if the multiparametric magnetic resonance imaging is positive or if 4Kscore 20 or greater or ExosomeDx 19 or greater would have missed 4.8% to 5.6% of Gleason grade 2 or greater prostate cancer in the biopsy group while avoiding 39.4% to 43.0% biopsies and 29.5% to 39.9% multiparametric magnetic resonance imaging overall. Similar algorithms with up-front multiparametric magnetic resonance imaging followed by liquid biomarker testing for negative multiparametric magnetic resonance imaging would have missed 2.4% of Gleason grade 2 or greater prostate cancer in the biopsy group but only avoided 17.2% 19.3% biopsies overall.
CONCLUSIONS
Screening algorithms with up-front liquid biomarker testing followed by multiparametric magnetic resonance imaging and biopsy at certain biomarker thresholds could reduce unnecessary biopsies, multiparametric magnetic resonance imaging and overdetection of Gleason grade 1 prostate cancer.
目的
我们旨在评估 4Kscore 和 ExosomeDx™ 联合多参数磁共振成像在高级别前列腺癌检测和避免活检数量方面的作用。
材料与方法
患者进行了 1 次液体生物标志物检测，联合或不联合多参数磁共振成像。高级别前列腺癌定义为 Gleason 分级组 2 级或更高。确定了总的避免活检数量（Gleason 分级 1 级或更低），以及活检患者中漏诊的 Gleason 分级 2 级或更高的癌症数量。
结果
在总队列的 783 例患者中，419 例（53.5%）进行了活检。4Kscore 和 ExosomeDx 评分高于制造商的截断点与 PI-RADS™ 评分 3 至 5 和 Gleason 分级 2 级或更高的前列腺癌相关。如果将液体生物标志物评分高于制造商截断点的患者限定为进行活检，则总体上可以避免 29.5%至 39.9%的不必要活检，而在活检组中漏诊 4.0%至 4.8%的 Gleason 分级 2 级或更高的前列腺癌。在进行液体生物标志物检测后，使用基于生物标志物的筛查算法，如果生物标志物高于制造商的截断点，则进行多参数磁共振成像，如果多参数磁共振成像阳性或 4Kscore 为 20 或更高或 ExosomeDx 为 19 或更高，则进行活检，在活检组中，这种筛查算法会漏诊 4.8%至 5.6%的 Gleason 分级 2 级或更高的前列腺癌，同时避免 39.4%至 43.0%的活检和总体上 29.5%至 39.9%的多参数磁共振成像。在基于多参数磁共振成像的筛查算法中，首先进行多参数磁共振成像，如果结果为阴性，则进行液体生物标志物检测，这种算法在活检组中会漏诊 2.4%的 Gleason 分级 2 级或更高的前列腺癌，但只能避免总体上 17.2%至 19.3%的活检。
结论
基于液体生物标志物检测，然后根据生物标志物阈值进行多参数磁共振成像和活检的筛查算法可以减少不必要的活检、多参数磁共振成像和 Gleason 分级 1 级前列腺癌的过度诊断。
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