Pang See-Tong, Lin Po-Hung, Berglund Emelie, Xu Lidi, Shao I-Hung, Yu Kai-Jie, Hsieh Chin-Hsuan, Chang Tzu-Hsuan, Chen Yu, Weng Wen-Hui, Chuang Cheng-Keng
Division of Urology, Department of Surgery Chang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan.
School of Medicine, College of Medicine Chang Gung University Taoyuan Taiwan.
BJUI Compass. 2025 May 29;6(6):e70026. doi: 10.1002/bco2.70026. eCollection 2025 Jun.
To evaluate the prognostic performance of the Prostatype® score (P-score) in the Asian prostate cancer (PCa) cohort and to assess its ability to refine risk stratification compared to the National Comprehensive Cancer Network (NCCN) guidelines. This study aimed to determine whether the P-score, previously validated in European populations, maintains its predictive accuracy in a genetically and clinically distinct high-risk Asian cohort, where late-stage diagnosis is more common.
This retrospective study included 148 PCa patients diagnosed at Taiwan Chang Gung Memorial Hospital between 2012 and 2017. Of these, 56 had primary metastases at diagnosis. The P-score was calculated based on gene expression in core needle biopsies and clinical data collected from patients' medical records. The primary endpoint was PCa-specific mortality (PCSM). The secondary endpoints were adverse pathology (AP) and biochemical failure.
The P-score significantly outperformed NCCN in predicting PCSM, achieving a higher C-index (0.90 vs. 0.73, P < 0.005), which reflects superior prognostic accuracy. Notably, 19.6% of patients were reclassified into different risk categories compared to NCCN, improving risk stratification and potentially altering treatment decisions for nearly one in five patients. The P-score was also an independent predictor of adverse pathology (P = 0.003, AUC: 0.81) and biochemical failure (P = 0.03, AUC: 0.89).
This study validated the P-score for the first time in a non-European population, confirming its predictive power in an Asian high-risk setting. The reclassification of 19.6% of patients suggests that the P-score refines risk stratification beyond NCCN, offering a more precise distinction between favourable and unfavourable outcomes, enabling more informed treatment decisions. These findings highlight the global applicability of the P-score and its potential to improve risk assessment and personalized treatment for PCa patients worldwide.
评估Prostatype®评分（P评分）在亚洲前列腺癌（PCa）队列中的预后性能，并评估其与美国国立综合癌症网络（NCCN）指南相比优化风险分层的能力。本研究旨在确定先前在欧洲人群中验证的P评分在遗传和临床特征不同的高危亚洲队列中是否保持其预测准确性，在该队列中晚期诊断更为常见。
这项回顾性研究纳入了2012年至2017年间在台湾长庚纪念医院诊断的148例PCa患者。其中，56例在诊断时已有原发转移。P评分基于核心针吸活检中的基因表达和从患者病历中收集的临床数据进行计算。主要终点是前列腺癌特异性死亡率（PCSM）。次要终点是不良病理（AP）和生化复发。
在预测PCSM方面，P评分显著优于NCCN，C指数更高（0.90对0.73，P < 0.005），这反映了更好的预后准确性。值得注意的是，与NCCN相比，19.6%的患者被重新分类到不同的风险类别，改善了风险分层，并可能改变近五分之一患者的治疗决策。P评分也是不良病理（P = 0.003，AUC：0.81）和生化复发（P = 0.03，AUC：0.89）的独立预测因素。
本研究首次在非欧洲人群中验证了P评分，证实了其在亚洲高危人群中的预测能力。19.6%的患者重新分类表明，P评分在NCCN之外进一步优化了风险分层，能更精确地区分有利和不利结局，有助于做出更明智的治疗决策。这些发现凸显了P评分的全球适用性及其改善全球PCa患者风险评估和个性化治疗的潜力。
