JAMA Oncology:一种新可以更好地预测非转移性前列腺癌患者预后的新分期系统

2020-10-25 MedSci原创 MedSci原创

密歇根大学罗格尔癌症中心的医生和生物统计学家开发和验证了一种新的分期系统,该系统可以更好地预测非转移性前列腺癌患者的预后,并为治疗决策提供信息。

前列腺癌是全世界男性最常见的癌症之一。局限性前列腺癌可以是惰性的,并不总是需要立即干预。与此相反,一些男性患有侵袭性局限性疾病,有较高的前列腺癌特异性死亡风险(PCSM),即使采用多种治疗方法。在局限性前列腺癌的临床应用中,没有前瞻性验证的预测性生物标志物,因此治疗建议是基于预后变量的。考虑到疾病严重程度的实质性异质性,对结果的准确估计和做出知情的治疗决定至关重要。而我们熟悉的数字分期系统(从1期到4期)尚未被纳入国家治疗指南或临床试验新药试验指南。

近期,一个被称为STAR-CAP的新系统发表在《美国医学会肿瘤学杂志》(JAMA Oncology)上,它利用来自美国、加拿大和欧洲55个中心的近20,000名患者的肿瘤和预后数据,创建了一个具有强大预后能力的稳健模型。

研究者试图利用现成的临床因素来开发和验证一种预处理临床预后分期系统。其目的是准确预测PCSM并改进AJCC现有的专家共识

从1992年到2013年,研究者收集了19 684例局限性前列腺癌患者(中位年龄64.0[四分位范围{IQR}, 59.0-70.0]年),并收集了完整的临床变量。另外收集了8337例男性患者的数据,但缺少该评分系统所需的临床变量。最常见的缺失元素是活检中核心活检阳性结果的百分比(n = 6246)。随访10年以上的4078例患者(20.7%)。

通过回归系数变换,为每个风险协变量赋值0 ~ 8,总可能点为0 ~ 27。将训练队列中具有相似PCSM预测的总分进行合并,最终形成9个分类组(0、1-2、3-4、5-6、7-8、9-10、11-12、13-16和17个,标记为IA-IIIC新阶段)。最低分组为0(新IA期)(验证队列中有1261例[12.9%]),10年PCSM估计为0.3%。最高得分组至少17(新IIIC期)(23[0.2%]验证队列),估计10年PCSM为40.0%。评分分期系统在现有的AJCC第8版中对每个阶段的患者进行了重新分类。

前列腺癌特异性死亡率(PCSM)预测的临床预后分期评分系统在验证队列中的应用

在验证队列中使用提议的临床预后分期组评分系统对当前美国癌症联合委员会(AJCC)第8版分期系统的重新分类

与现有的AJCC第8版相比,评分分级系统的鉴别、校准和总体性能指标表现良好。10年评分C指数0.796 (95% CI 0.760-0.828)超过了AJCC第8版C指数0.757 (95% CI 0.719-0.792)。

C指数的值越高,识别效果越好。

与AJCC第8版现有的预后分期相比,新的评分分组系统更符合PCSM的结果,从而为告知患者预期结果提供了重要数据。评分分组系统还为将来可能产生于不同研究环境的临床试验设计提供了共同的基础,例如在不同的国家临床试验网络组中。

总之,研究者指出:“我们开发并验证了一种与AJCC兼容的临床预后组分期系统,该系统可用于全球范围内的非转移性前列腺癌患者,其性能优于目前的AJCC第8版。我们的评分系统为支持新前列腺癌分期系统提供了高质量的证据”

参考文献:

  1. Robert T. Dess,et,al. Development and Validation of a Clinical Prognostic Stage Group System for Nonmetastatic Prostate Cancer Using Disease-Specific Mortality Results From the International Staging Collaboration for Cancer of the ProstateJAMA Oncology, 2020; DOI: 10.1001/jamaoncol.2020.4922

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authenticateStatus=null, createdAvatar=null, createdBy=022b17724229, createdName=jinweidong, createdTime=Tue Oct 27 11:44:26 CST 2020, time=2020-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=894448, encodeId=a904894448c1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64195213161, createdName=147642a4m23暂无昵称, createdTime=Mon Oct 26 01:16:34 CST 2020, time=2020-10-26, status=1, ipAttribution=)]
    2021-07-15 minlingfeng
  4. 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  5. 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  6. 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  7. 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encodeId=9cd91395553b1, content=<a href='/topic/show?id=7bbf93405a5' target=_blank style='color:#2F92EE;'>#转移性前列腺癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93405, encryptionId=7bbf93405a5, topicName=转移性前列腺癌)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/656F31B644588474D1C46903A7F84373/100, createdBy=4e842500199, createdName=ms24272190615788285182, createdTime=Tue Oct 27 11:44:26 CST 2020, time=2020-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589476, encodeId=3cb615894e688, content=<a href='/topic/show?id=74ff99695f0' target=_blank style='color:#2F92EE;'>#非转移性前列腺癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99695, encryptionId=74ff99695f0, topicName=非转移性前列腺癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=022b17724229, createdName=jinweidong, createdTime=Tue Oct 27 11:44:26 CST 2020, time=2020-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=894448, encodeId=a904894448c1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64195213161, createdName=147642a4m23暂无昵称, createdTime=Mon Oct 26 01:16:34 CST 2020, time=2020-10-26, status=1, ipAttribution=)]
    2020-10-26 147642a4m23暂无昵称

    学习了

    0