Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
Department of Urology, Charité Universitätsmedizin, Berlin, Germany.
Clin Genitourin Cancer. 2021 Aug;19(4):296-304.e3. doi: 10.1016/j.clgc.2021.01.003. Epub 2021 Jan 19.
The combined clinical cell-cycle risk (CCR) score is a validated model that combines the cell-cycle progression (CCP) score with the University of California San Francisco Cancer of the Prostate Risk Assessment (CAPRA) score. This score determines the risk of progressive disease for men with prostate cancer. Here, we further validate the prognostic ability of the CCR score and evaluate its ability to help determine which patients may safely forgo multimodality therapy.
We evaluated the CCR and a CCR-based multimodality threshold (2.112) in a retrospective, multi-institutional cohort of men with National Comprehensive Cancer Network intermediate- or high-risk localized disease (N = 718). These men received single or multimodality therapy (androgen deprivation with radiation [RT], or surgery with adjuvant RT or hormones).
CCR score prognosticated metastasis for single-modality therapy, as a continuous variable (hazard ratio, 3.97; 95% confidence interval [CI], 2.61-6.06) and when dichotomized at the threshold (hazard ratio, 15.90; 95% CI, 5.43-46.52). The 10-year Kaplan-Meier risk for those receiving single-modality (RT or surgical) therapy with CCR scores below and above the threshold for single-modality treatment was 4.3% (95% CI, 1.0%-17.1%) and 20.4% (95% CI, 13.2%-30.7%), respectively. Using the threshold, 27% of men with newly diagnosed high-risk and 73% with unfavorable intermediate-risk disease could avoid multimodality therapy.
Patients with CCR scores below the multimodality threshold (2.112) may safely forgo multimodality therapy. The CCR score can be used as a decision aid to counsel men whether or not single-modality therapy would be sufficient for their intermediate- or high-risk prostate cancer.
联合临床细胞周期风险（CCR）评分是一种经过验证的模型，它将细胞周期进展（CCP）评分与加利福尼亚大学旧金山前列腺癌风险评估（CAPRA）评分相结合。该评分可确定患有前列腺癌的男性发生进展性疾病的风险。在这里，我们进一步验证了 CCR 评分的预后能力，并评估了其帮助确定哪些患者可以安全地避免多模式治疗的能力。
我们评估了 CCR 评分和基于 CCR 的多模式阈值（2.112）在一个回顾性、多机构队列中的作用，该队列包括患有国家综合癌症网络（NCCN）中危或高危局限性疾病的男性（N=718）。这些男性接受了单一或多模式治疗（雄激素剥夺加放疗[RT]或手术加辅助 RT 或激素）。
CCR 评分作为连续变量（危险比，3.97；95%置信区间[CI]，2.61-6.06）和在阈值处二分（危险比，15.90；95%CI，5.43-46.52）时预测了单一模式治疗的转移。接受单一模式（RT 或手术）治疗且 CCR 评分低于和高于单一模式治疗阈值的患者，10 年 Kaplan-Meier 风险分别为 4.3%（95%CI，1.0%-17.1%）和 20.4%（95%CI，13.2%-30.7%）。使用该阈值，新诊断的高危患者中有 27%和不利的中危疾病患者中有 73%可以避免多模式治疗。
CCR 评分低于多模式阈值（2.112）的患者可以安全地避免多模式治疗。CCR 评分可用作决策辅助工具，以告知男性是否单一模式治疗足以治疗其中危或高危前列腺癌。
