Renavikar Pranav S, LaGrange Chad A, Lele Subodh M
From the Department of Pathology and Microbiology (Renavikar, Lele), University of Nebraska Medical Center, Omaha, Nebraska.
The Division of Urologic Surgery in the Department of Surgery (LaGrange), University of Nebraska Medical Center, Omaha, Nebraska.
Arch Pathol Lab Med. 2023 Oct 1;147(10):1158-1163. doi: 10.5858/arpa.2022-0225-OA.
CONTEXT.—: Low-risk (Gleason score 3 + 3 = 6) and intermediate-risk (Gleason score 3 + 4 = 7) prostate carcinoma cases diagnosed on needle biopsies are frequently referred for gene expression studies such as Oncotype DX to help validate the risk. Risk assessment helps in determining prognosis and therapeutic decision making.
OBJECTIVE.—: To determine if addition of molecular testing is necessary, by evaluating its correlation with risk stratification provided by pathology report (Gleason score, Grade Group, proportion of positive cores) and serum prostate-specific antigen (PSA) level.
DESIGN.—: Our institutional database was searched for cases that had Oncotype DX testing after prostate biopsy. The final risk category determined by molecular testing was compared to the risk stratification predicted by the pathology report and serum PSA levels. Cases were classified as concordant if they fell under the same National Comprehensive Cancer Network risk and recommended initial therapy group. Follow-up information on discordant cases was obtained and used to determine if risk stratification by molecular testing was superior to that obtained from the clinicopathologic data.
RESULTS.—: A total of 4967 prostate biopsies (2015-2020) were screened. Of these, 131 prostate carcinoma cases (2.6%) had Oncotype DX testing and 111 of 131 cases (85%) had follow-up information. There was risk stratification concordance in 93 of 111 cases (84%). All 18 of 111 cases (16%) that were discordant had a follow-up course that matched the risk predicted by pathology data and serum PSA.
CONCLUSIONS.—: Risk stratification provided by information in the pathology report on routine biopsy assessment coupled with the serum PSA level is equivalent to that obtained by Oncotype DX testing.
经穿刺活检诊断为低风险（Gleason评分3 + 3 = 6）和中风险（Gleason评分3 + 4 = 7）的前列腺癌病例经常被转诊进行基因表达研究，如Oncotype DX检测，以帮助验证风险。风险评估有助于确定预后和治疗决策。
通过评估分子检测与病理报告（Gleason评分、分级组、阳性核心比例）和血清前列腺特异性抗原（PSA）水平提供的风险分层之间的相关性，确定是否有必要进行分子检测。
在我们的机构数据库中搜索前列腺活检后进行Oncotype DX检测的病例。将分子检测确定的最终风险类别与病理报告和血清PSA水平预测的风险分层进行比较。如果病例属于相同的美国国立综合癌症网络风险和推荐的初始治疗组，则分类为一致。获取不一致病例的随访信息，并用于确定分子检测的风险分层是否优于临床病理数据获得的风险分层。
共筛选了4967例前列腺活检病例（2015 - 2020年）。其中，131例前列腺癌病例（2.6%）进行了Oncotype DX检测，131例中的111例（85%）有随访信息。111例中的93例（84%）存在风险分层一致性。111例中所有18例（16%）不一致的病例其随访过程与病理数据和血清PSA预测的风险相符。
常规活检评估的病理报告信息与血清PSA水平提供的风险分层等同于Oncotype DX检测获得的风险分层。
