Boyer Matthew J, Carpenter David J, Gingrich Jeffrey R, Raman Sudha R, Sirohi Deepika, Tabriz Amir Alishahi, Rompre-Broduer Alexis, Lunyera Joseph, Basher Fahmin, Bitting Rhonda L, Kosinski Andrzej, Cantrell Sarah, Gordon Adelaide M, Ear Belinda, Gierisch Jennifer M, Jacobs Morgan, Goldstein Karen M
Durham VA Health Care System, Durham, NC, USA.
Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, USA.
Prostate Cancer Prostatic Dis. 2025 Mar;28(1):103-111. doi: 10.1038/s41391-023-00766-z. Epub 2024 Jan 10.
Refinement of the risk classification for localized prostate cancer is warranted to aid in clinical decision making. A systematic analysis was undertaken to evaluate the prognostic ability of three genomic classifiers, Decipher, GPS, and Prolaris, for biochemical recurrence, development of metastases and prostate cancer-specific mortality in patients with localized prostate cancer.
Data sources: MEDLINE, Embase, and Web of Science were queried for reports published from January 2010 to April 2022.
prospective or retrospective studies reporting prognosis for patients with localized prostate cancer.
relevant data were extracted into a customized database by one researcher with a second overreading. Risk of bias was assessed using a validated tool for prognostic studies, Quality in Prognosis Studies (QUIPS). Disagreements were resolved by consensus or by input from a third reviewer. We assessed the certainty of evidence by GRADE incorporating adaptation for prognostic studies.
Data synthesis: a total of 39 studies (37 retrospective) involving over 10,000 patients were identified. Twenty-two assessed Decipher, 5 GPS, and 14 Prolaris. Thirty-four studies included patients who underwent prostatectomy. Based on very low to low certainty of evidence, each of the three genomic classifiers modestly improved upon the prognostic ability for biochemical recurrence, development of metastases, and prostate cancer-specific mortality compared to standard clinical risk-classification schemes.
downgrading of confidence in the evidence stemmed largely from bias due to the retrospective nature of the studies, heterogeneity in treatment received, and era in which patients were treated (i.e., prior to the 2000s).
Genomic classifiers provide a small but consistent improvement upon the prognostic ability of clinical classification schemes, which may be helpful when treatment decisions are uncertain. However, evidence from current management-era data and of the predictive ability of these tests is needed.
有必要完善局限性前列腺癌的风险分类，以辅助临床决策。开展了一项系统分析，以评估三种基因组分类器（Decipher、GPS和Prolaris）对局限性前列腺癌患者生化复发、转移发展及前列腺癌特异性死亡率的预后能力。
数据来源：检索MEDLINE、Embase和Web of Science中2010年1月至2022年4月发表的报告。
报告局限性前列腺癌患者预后的前瞻性或回顾性研究。
由一名研究人员将相关数据提取到定制数据库中，另一名研究人员进行复核。使用经过验证的预后研究工具“预后研究质量（QUIPS）”评估偏倚风险。分歧通过协商一致或由第三位审阅者提供意见来解决。我们采用GRADE并结合对预后研究的调整来评估证据的确定性。
数据综合：共纳入39项研究（37项回顾性研究），涉及10000多名患者。22项评估Decipher，5项评估GPS，14项评估Prolaris。34项研究纳入了接受前列腺切除术的患者。基于极低至低确定性的证据，与标准临床风险分类方案相比，这三种基因组分类器中的每一种在生化复发、转移发展及前列腺癌特异性死亡率的预后能力方面均有适度改善。
对证据信心的降低主要源于研究的回顾性性质、所接受治疗的异质性以及患者接受治疗的时代（即21世纪之前）导致的偏倚。
基因组分类器在临床分类方案的预后能力基础上有小幅但一致的改善，在治疗决策不确定时可能会有所帮助。然而，需要来自当前管理时代数据以及这些检测预测能力的证据。
