TY - JOUR
T1 - Preoperative Risk-Stratification of High-Risk Prostate Cancer
T2 - A Multicenter Analysis
AU - Chys, Brecht
AU - Devos, Gaëtan
AU - Everaerts, Wouter
AU - Albersen, Maarten
AU - Moris, Lisa
AU - Claessens, Frank
AU - De Meerleer, Gert
AU - Haustermans, Karin
AU - Briganti, Alberto
AU - Chlosta, Piotr
AU - Gontero, Paolo
AU - Graefen, Markus
AU - Gratzke, Christian
AU - Karnes, R. Jeffrey
AU - Kneitz, Burkhard
AU - Marchioro, Giansilvio
AU - Salas, Rafael Sanchez
AU - Spahn, Martin
AU - Tombal, Bertrand
AU - Van Der Poel, Henk
AU - Walz, Jochen
AU - Van Poppel, Hendrik
AU - Joniau, Steven
N1 - Publisher Copyright:
© Copyright © 2020 Chys, Devos, Everaerts, Albersen, Moris, Claessens, De Meerleer, Haustermans, Briganti, Chlosta, Gontero, Graefen, Gratzke, Karnes, Kneitz, Marchioro, Salas, Spahn, Tombal, Van Der Poel, Walz, Van Poppel and Joniau.
PY - 2020/3/6
Y1 - 2020/3/6
N2 - Background: Cancer-specific survival (CSS) within high-risk non-metastatic prostate cancer varies dramatically. It is likely that within this heterogenous population there are subgroup(s) at extraordinary risk, burdened with an exaptational poor prognosis. Establishing the characteristics of these group(s) would have significant clinical implications since high quality preoperative risk stratification remains the cornerstone of therapeutic decision making to date. Objective: To stratify high-risk prostate cancer based on preoperative characteristics and evaluate cancer specific survival after radical prostatectomy. Method: The EMPaCT multi-center database offers an international population of non-metastatic high-risk prostate cancer. Preoperative characteristics such as age, biopsy Gleason score, PSA and clinical stage were subcategorized. A multivariate analysis was performed using predictors showing significant survival heterogeneity after stratification, as observed by a univariate analysis. Based upon the hazard ratios of this multivariate analysis, a proportional score system was created. The most ideal group distribution was evaluated trough different score cut-off's. The predictive value was tested by the herald C index. Results: An overall 5-years CSS of 94% was noted within the entire high-risk cohort (n = 4,879). Except for age, all preoperative risk factors showed a significantly differing CSS. Multivariate analysis indicated, T4 stage as being the strongest predictor of CSS (HR: 3.31), followed by ISUP grade 5 group (HR 3,05). A score system was created by doubling the hazard ratios of this multivariate analysis and rounding off to the nearest complete number. Multivariate analysis suggested 0, 4, 8, and 12 pts as being the most optimal group distribution (p-value: 0.0015). Five-years CSS of these groups were 97, 93, 87, and 70%, respectively. The calculated Herald C-index of the model was 0.77. Conclusion: An easy-to-use pre-operative model for risk stratification of newly diagnosed high-risk prostate cancer is presented. The heterogeneous CSS of high-risk non-metastatic prostate cancer after radical prostatectomy is illustrated. The model is clinically accessible through an online calculator, presenting cancer specific survival based on individualized patient characteristics.
AB - Background: Cancer-specific survival (CSS) within high-risk non-metastatic prostate cancer varies dramatically. It is likely that within this heterogenous population there are subgroup(s) at extraordinary risk, burdened with an exaptational poor prognosis. Establishing the characteristics of these group(s) would have significant clinical implications since high quality preoperative risk stratification remains the cornerstone of therapeutic decision making to date. Objective: To stratify high-risk prostate cancer based on preoperative characteristics and evaluate cancer specific survival after radical prostatectomy. Method: The EMPaCT multi-center database offers an international population of non-metastatic high-risk prostate cancer. Preoperative characteristics such as age, biopsy Gleason score, PSA and clinical stage were subcategorized. A multivariate analysis was performed using predictors showing significant survival heterogeneity after stratification, as observed by a univariate analysis. Based upon the hazard ratios of this multivariate analysis, a proportional score system was created. The most ideal group distribution was evaluated trough different score cut-off's. The predictive value was tested by the herald C index. Results: An overall 5-years CSS of 94% was noted within the entire high-risk cohort (n = 4,879). Except for age, all preoperative risk factors showed a significantly differing CSS. Multivariate analysis indicated, T4 stage as being the strongest predictor of CSS (HR: 3.31), followed by ISUP grade 5 group (HR 3,05). A score system was created by doubling the hazard ratios of this multivariate analysis and rounding off to the nearest complete number. Multivariate analysis suggested 0, 4, 8, and 12 pts as being the most optimal group distribution (p-value: 0.0015). Five-years CSS of these groups were 97, 93, 87, and 70%, respectively. The calculated Herald C-index of the model was 0.77. Conclusion: An easy-to-use pre-operative model for risk stratification of newly diagnosed high-risk prostate cancer is presented. The heterogeneous CSS of high-risk non-metastatic prostate cancer after radical prostatectomy is illustrated. The model is clinically accessible through an online calculator, presenting cancer specific survival based on individualized patient characteristics.
KW - EMPACT
KW - high risk prostate cancer
KW - prostate
KW - prostate cancer
KW - risk stratification
UR - http://www.scopus.com/inward/record.url?scp=85082685150&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85082685150&partnerID=8YFLogxK
U2 - 10.3389/fonc.2020.00246
DO - 10.3389/fonc.2020.00246
M3 - Article
AN - SCOPUS:85082685150
SN - 2234-943X
VL - 10
JO - Frontiers in Oncology
JF - Frontiers in Oncology
M1 - 246
ER -