应用推荐的侵袭性前列腺癌定义：利用挪威癌症登记处高质量数据进行的验证研究。
Applying recommended definition of aggressive prostate cancer: a validation study using high-quality data from the Cancer Registry of Norway.
机构信息
Department of Research, Cancer Registry of Norway, Oslo, Norway.
Department of Cancer Genetics, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
出版信息
Acta Oncol. 2023 Jan;62(1):8-14. doi: 10.1080/0284186X.2023.2175331. Epub 2023 Feb 10.
BACKGROUND
The Prostate Cancer Cohort Consortium (PC3) Working Group proposed a definition for aggressive prostate cancer (PC) for aetiologic epidemiologic research. We aimed to validate this definition as well as a second approach utilising only information on stage at diagnosis.
METHODS
First primary PCs diagnosed 2004 - 2009 in the population-based Janus Serum Bank (JSB) cohort were identified by linkage to the population-based Cancer Registry of Norway (CRN) ( = 3568). The CRN and Norwegian Prostate Cancer Registry provided clinicopathological data for these cases. Approach 1 classified PC as aggressive if it was clinically T4, or N1, or M1, or had a Gleason score ≥8 at diagnosis (as proposed). Approach 2 classified PC as aggressive if CRN stage at diagnosis was 'regional spread' or 'distant metastases'. Both approaches were validated by calculating the sensitivity and positive predictive value (PPV) against PC-death within 10 years of diagnosis.
RESULTS
Overall, 555 died from PC within 10 years. Approach 1 classified 24.7% of cases as aggressive and 13.6% were unclassified due to missing information. Approach 2 classified 19.6% as aggressive and 29% were unclassified. Sensitivity was highest for Approach 1 (0.76, 95% CI: 0.72 - 0.80 vs 0.69, 95% CI: 0.64 - 0.73), while PPVs were similar for both approaches (0.43, 95% CI: 0.40 - 0.46 and 0.40, 95% CI: 0.36 - 0.44). We observed similarly high sensitivity and higher PPVs than those reported by the PC3 Working Group.
CONCLUSIONS
The proposed definition of aggressive PC was applicable and valid in the JSB cohort. Stage at diagnosis can be useful if data on cTNM or Gleason score is unavailable.
背景
前列腺癌队列联合会（PC3）工作组提出了一种用于病因流行病学研究的侵袭性前列腺癌（PC）定义。我们旨在验证该定义以及仅利用诊断时分期信息的第二种方法。
方法
通过与基于人群的挪威癌症登记处（CRN）的链接，确定了 2004 年至 2009 年在基于人群的扬斯血清库（JSB）队列中首次诊断的原发性前列腺癌（JSB）（=3568）。CRN 和挪威前列腺癌登记处为这些病例提供了临床病理数据。方法 1 将临床 T4、N1、M1 或诊断时 Gleason 评分≥8 的 PC 定义为侵袭性（如提出的）。方法 2 将 CRN 诊断时的分期为“区域扩散”或“远处转移”的 PC 定义为侵袭性。通过计算诊断后 10 年内 PC 死亡的敏感性和阳性预测值（PPV）来验证这两种方法。
结果
总体而言，在诊断后 10 年内有 555 人死于 PC。方法 1 将 24.7%的病例归类为侵袭性，由于信息缺失，有 13.6%的病例未分类。方法 2 将 19.6%的病例归类为侵袭性，有 29%的病例未分类。方法 1 的敏感性最高（0.76，95%CI：0.72-0.80 比 0.69，95%CI：0.64-0.73），而两种方法的 PPV 相似（0.43，95%CI：0.40-0.46 和 0.40，95%CI：0.36-0.44）。我们观察到的敏感性与 PC3 工作组报告的相似，而 PPV 则更高。
结论
该研究提出的侵袭性 PC 定义在 JSB 队列中是适用且有效的。如果无法获得 cTNM 或 Gleason 评分数据，诊断时的分期可能很有用。
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