Development and validation of a novel risk score for the detection of insignificant prostate cancer in unscreened patient cohorts
Menée à partir de données portant sur 2 799 patients atteints d'un cancer de la prostate traité par prostatectomie radicale entre 2006 et 2016 (score de Gleason 3+3 à la biopsie) puis validée sur 441 patients complémentaires, cette étude évalue, par rapport à d'autres outils prédictifs, la précision d'un système de score, basé sur le niveau du PSA, le volume de la tumeur, son stade, l'âge du patient, le pourcentage et le nombre de prélèvements biopsiques positifs, pour identifier un cancer de la prostate non significatif et recommander une surveillance active aux patients concernés
Background : Active surveillance is recommended for insignificant prostate cancer (PCa). Tools exist to identify suitable candidates using clinical variables. We aimed to develop and validate a novel risk score (NRS) predicting which patients are harbouring insignificant PCa.
Methods : We used prospectively collected data from 8040 consecutive unscreened patients who underwent radical prostatectomy between 2006 and 2016. Of these, data from 2799 patients with Gleason 3 + 3 on biopsy were used to develop a multivariate model predicting the presence of insignificant PC at radical prostatectomy (ERSPC updated definition3: Gleason 3 + 3 only, index tumour volume < 1.3 cm3 and total tumour volume < 2.5 cm3). This was used to develop a novel risk score (NRS) which was validated in an equivalent independent cohort (n = 441). We compared the accuracy of existing predictive tools and the NRS in these cohorts.
Results : The NRS (incorporating PSA, prostate volume, age, clinical T Stage, percent and number of positive biopsy cores) outperformed pre-existing predictive tools in derivation and validation cohorts (AUC 0.755 and 0.76, respectively). Selection bias due to analysis of a surgical cohort is acknowledged.
Conclusions : The advantage of the NRS is that it can be tailored to patient characteristics and may prove to be valuable tool in clinical decision-making.
British Journal of Cancer , résumé, 2018