Research Service, Durham VA Health Care System, Durham, North Carolina.
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina; Radiation Oncology Service, Durham VA Health Care System, Durham, North Carolina.
Int J Radiat Oncol Biol Phys. 2023 Jan 1;115(1):120-131. doi: 10.1016/j.ijrobp.2022.06.101. Epub 2022 Oct 25.
The Oncotype DX Genomic Prostate Score (GPS) assay has been validated as a strong prognostic indicator of adverse pathology, biochemical recurrence, distant metastasis (DM), and prostate cancer (PCa)-related death (PCD) in men with localized PCa after radical prostatectomy. However, it has yet to be tested in men undergoing external beam radiation therapy (EBRT), for whom assessing PCa progression risk could inform decisions on treatment intensity. We analyzed whether GPS results are associated with time to biochemical failure (BCF), DM, and PCD after EBRT in men with localized PCa and whether the association is modified by race.
We conducted a retrospective study of men with localized PCa treated with EBRT at the VA Health Care System in Durham, NC from 2000 to 2016. Study endpoints were time to BCF per the Phoenix criteria, DM, and PCD. The association of GPS results, per 20-unit increase or dichotomous variable (0-40 vs 41-100), was evaluated with each endpoint using univariable and multivariable Cox proportional hazards models. Results were then stratified by race.
A total of 238 patients (69% Black) met the eligibility criteria. Median follow-up for patients who did not experience BCF was 7.6 years. GPS results per 20-unit increase were significantly associated with BCF (hazard ratio [HR], 3.62; 95% confidence interval [CI], 2.59-5.02), DM (HR, 4.48; 95% CI, 2.75-7.38), and PCD (HR, 5.36; 95% CI, 3.06-9.76) in univariable analysis. GPS results remained significant in multivariable models adjusted for baseline clinical and pathological factors, with HRs being similar to the univariable analysis. There was no significant interaction between the GPS assay and race (P = .923). HRs for BCF were similar in Black men (HR, 3.88; 95% CI, 2.40-6.24) versus non-Black men (HR, 4.01; 95% CI, 2.42-6.45).
Among men treated with EBRT, the GPS assay is a strong, independent prognostic indicator of time to BCF, DM, and PCD, and performs similarly in Black and non-Black men.
Oncotype DX 基因组前列腺评分（GPS）检测已被验证为一种强有力的预后指标，可预测接受根治性前列腺切除术的局限性前列腺癌（PCa）男性的不良病理、生化复发、远处转移（DM）和 PCa 相关死亡（PCD）。然而，它尚未在接受外照射放疗（EBRT）的男性中进行测试，对于这些男性，评估 PCa 进展风险可以为治疗强度的决策提供信息。我们分析了 GPS 结果是否与局限性前列腺癌男性接受 EBRT 后生化失败（BCF）、DM 和 PCD 的时间相关，以及这种关联是否受种族影响。
我们对 2000 年至 2016 年在北卡罗来纳州达勒姆退伍军人事务医疗保健系统接受 EBRT 治疗的局限性前列腺癌男性进行了回顾性研究。研究终点为根据凤凰标准的 BCF 时间、DM 和 PCD。使用单变量和多变量 Cox 比例风险模型评估 GPS 结果（每增加 20 个单位或二分类变量[0-40 与 41-100]）与每个终点的关系。然后根据种族对结果进行分层。
共有 238 名患者（69%为黑人）符合入选标准。未发生 BCF 的患者中位随访时间为 7.6 年。GPS 结果每增加 20 个单位与 BCF（风险比[HR]，3.62；95%置信区间[CI]，2.59-5.02）、DM（HR，4.48；95% CI，2.75-7.38）和 PCD（HR，5.36；95% CI，3.06-9.76）显著相关。在调整基线临床和病理因素的多变量模型中，GPS 结果仍然显著，HR 与单变量分析相似。GPS 检测与种族之间没有显著的交互作用（P=0.923）。黑人男性（HR，3.88；95% CI，2.40-6.24）与非黑人男性（HR，4.01；95% CI，2.42-6.45）的 BCF 风险相似。
在接受 EBRT 治疗的男性中，GPS 检测是 BCF、DM 和 PCD 时间的一个强有力的独立预后指标，在黑人男性和非黑人男性中的表现相似。
