Xie Mu, Gao Xian-Shu, Ma Ming-Wei, Gu Xiao-Bin, Li Hong-Zhen, Lyu Feng, Bai Yun, Chen Jia-Yan, Ren Xue-Ying, Liu Ming-Zhu
Department of Radiation Oncology, Peking University First Hospital, Beijing, China.
Department of Radiation Oncology, Zhengzhou University First Affiliated Hospital, Zhengzhou, China.
Front Oncol. 2021 Apr 13;11:646073. doi: 10.3389/fonc.2021.646073. eCollection 2021.
It is not known which risk stratification system has the best discrimination ability for predicting prostate cancer death.
We identified patients with non-metastatic primary prostate adenocarcinoma diagnosis between 2004 and 2015 using the Surveillance, Epidemiology, and End Results database. Patients were categorized in different risk groups using the three frequently used risk stratification systems of the National Comprehensive Cancer Network guideline (NCCN-g), American Urological Association guideline (AUA-g), and European Association of Urology guideline (EAU-g), respectively. Associations between risk classification and prostate cancer-specific mortality (PCSM) were determined using Kaplan-Meier analyses and multivariable regression with Cox proportional hazards model. Area under the receiver operating characteristics curve (AUC) analyses were used to test the discrimination ability of the three risk grouping systems.
We analyzed 310,062 patients with a median follow-up of 61 months. A total of 36,368 deaths occurred, including 6,033 prostate cancer deaths. For all the three risk stratification systems, the risk groups were significantly associated with PCSM. The AUC of the model relying on NCCN-g, AUA-g, and EAU-g risk stratification systems for PCSM at specifically 8 years were 0.818, 0.793, and 0.689 in the entire population; 0.819, 0.795, and 0.691 in Whites; 0.802, 0.777, and 0.681 in Blacks; 0.862, 0.818, and 0.714 in Asians; 0.845, 0.806, and 0.728 in Chinese patients. Regardless of the age, marital status, socioeconomic status, and treatment modality, AUC of the model relying on NCCN-g and AUA-g for PCSM was greater than that relying on EAU-g; AUC of the model relying on NCCN-g system was greater than that of the AUA-g system.
The NCCN-g and AUA-g risk stratification systems perform better in discriminating PCSM compared to the EAU-g system. The discrimination ability of the NCCN-g system was better than that of the AUA-g system. It is recommended to use NCCN-g to evaluate risk groups for prostate cancer patients and then provide more appropriate corresponding treatment recommendations.
尚不清楚哪种风险分层系统在预测前列腺癌死亡方面具有最佳的辨别能力。
我们使用监测、流行病学和最终结果数据库，确定了2004年至2015年间诊断为非转移性原发性前列腺腺癌的患者。分别使用美国国立综合癌症网络指南（NCCN-g）、美国泌尿外科学会指南（AUA-g）和欧洲泌尿外科学会指南（EAU-g）这三种常用的风险分层系统，将患者分为不同的风险组。使用Kaplan-Meier分析和Cox比例风险模型的多变量回归确定风险分类与前列腺癌特异性死亡率（PCSM）之间的关联。使用受试者工作特征曲线（AUC）下面积分析来测试这三种风险分组系统的辨别能力。
我们分析了310,062例患者，中位随访时间为61个月。共发生36,368例死亡，其中包括6,033例前列腺癌死亡。对于所有这三种风险分层系统，风险组与PCSM均显著相关。在整个队列中，依赖NCCN-g）、AUA-g和EAU-g风险分层系统的模型在8年时PCSM的AUC分别为0.818、0.793和0.689；在白人中分别为0.819、0.795和0.691；在黑人中分别为0.802、0.777和0.681；在亚洲人中分别为0.862、0.818和0.714；在中国患者中分别为0.845、0.806和0.728。无论年龄、婚姻状况、社会经济状况和治疗方式如何，依赖NCCN-g和AUA-g的模型对于PCSM的AUC均大于依赖EAU-g的模型；依赖NCCN-g系统的模型的AUC大于AUA-g系统的模型。
与EAU-g系统相比，NCCN-g和AUA-g风险分层系统在辨别PCSM方面表现更好。NCCN-g系统的辨别能力优于AUA-g系统。建议使用NCCN-g来评估前列腺癌患者的风险组，然后提供更合适的相应治疗建议。
