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Validation of the Decipher Test for predicting adverse pathology in candidates for prostate cancer active surveillance
BACKGROUND: Many men diagnosed with prostate cancer are active surveillance (AS) candidates. However, AS may be associated with increased risk of disease progression and metastasis due to delayed therapy. Genomic classifiers, e.g., Decipher, may allow better risk-stratify newly diagnosed prostate ca...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6760567/ https://www.ncbi.nlm.nih.gov/pubmed/30542054 http://dx.doi.org/10.1038/s41391-018-0101-6 |
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author | Kim, Hyung L. Li, Ping Huang, Huei-Chung Deheshi, Samineh Marti, Tara Knudsen, Beatrice Abou-Ouf, Hatem Alam, Ridwan Lotan, Tamara L. Lam, Lucia L. C. du Plessis, Marguerite Davicioni, Elai Fleshner, Neil Lane, Brian R. Ross, Ashley E. Davis, John W. Mohler, James L. Trock, Bruce J. Klein, Eric A. Tosoian, Jeffrey J. Hyndman, M. Eric Bismar, Tarek A. |
author_facet | Kim, Hyung L. Li, Ping Huang, Huei-Chung Deheshi, Samineh Marti, Tara Knudsen, Beatrice Abou-Ouf, Hatem Alam, Ridwan Lotan, Tamara L. Lam, Lucia L. C. du Plessis, Marguerite Davicioni, Elai Fleshner, Neil Lane, Brian R. Ross, Ashley E. Davis, John W. Mohler, James L. Trock, Bruce J. Klein, Eric A. Tosoian, Jeffrey J. Hyndman, M. Eric Bismar, Tarek A. |
author_sort | Kim, Hyung L. |
collection | PubMed |
description | BACKGROUND: Many men diagnosed with prostate cancer are active surveillance (AS) candidates. However, AS may be associated with increased risk of disease progression and metastasis due to delayed therapy. Genomic classifiers, e.g., Decipher, may allow better risk-stratify newly diagnosed prostate cancers for AS. METHODS: Decipher was initially assessed in a prospective cohort of prostatectomies to explore the correlation with clinically meaningful biologic characteristics and then assessed in diagnostic biopsies from a retrospective multicenter cohort of 266 men with National Comprehensive Cancer Network (NCCN) very low/low and favorable-intermediate risk prostate cancer. Decipher and Cancer of the Prostate Risk Assessment (CAPRA) were compared as predictors of adverse pathology (AP) for which there is universal agreement that patients with long life-expectancy are not suitable candidates for AS (primary pattern 4 or 5, advanced local stage [pT3b or greater] or lymph node involvement). RESULTS: Decipher from prostatectomies was significantly associated with adverse pathologic features (p-values < 0.001). Decipher from the 266 diagnostic biopsies (64.7% NCCN-very-low/low and 35.3% favorable-intermediate) was an independent predictor of AP (odds ratio 1.29 per 10% increase, 95% confidence interval [CI] 1.03–1.61, p-value 0.025) when adjusting for CAPRA. CAPRA area under curve (AUC) was 0.57, (95% CI 0.47–0.68). Adding Decipher to CAPRA increased the AUC to 0.65 (95% CI 0.58–0.70). NPV, which determines the degree of confidence in the absence of AP for patients, was 91% (95% CI 87–94%) and 96% (95% CI 90–99%) for Decipher thresholds of 0.45 and 0.2, respectively. Using a threshold of 0.2, Decipher was a significant predictor of AP when adjusting for CAPRA (p-value 0.016). CONCLUSION: Decipher can be applied to prostate biopsies from NCCN-very-low/low and favorable-intermediate risk patients to predict absence of adverse pathologic features. These patients are predicted to be good candidates for active surveillance. |
format | Online Article Text |
id | pubmed-6760567 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-67605672019-09-26 Validation of the Decipher Test for predicting adverse pathology in candidates for prostate cancer active surveillance Kim, Hyung L. Li, Ping Huang, Huei-Chung Deheshi, Samineh Marti, Tara Knudsen, Beatrice Abou-Ouf, Hatem Alam, Ridwan Lotan, Tamara L. Lam, Lucia L. C. du Plessis, Marguerite Davicioni, Elai Fleshner, Neil Lane, Brian R. Ross, Ashley E. Davis, John W. Mohler, James L. Trock, Bruce J. Klein, Eric A. Tosoian, Jeffrey J. Hyndman, M. Eric Bismar, Tarek A. Prostate Cancer Prostatic Dis Article BACKGROUND: Many men diagnosed with prostate cancer are active surveillance (AS) candidates. However, AS may be associated with increased risk of disease progression and metastasis due to delayed therapy. Genomic classifiers, e.g., Decipher, may allow better risk-stratify newly diagnosed prostate cancers for AS. METHODS: Decipher was initially assessed in a prospective cohort of prostatectomies to explore the correlation with clinically meaningful biologic characteristics and then assessed in diagnostic biopsies from a retrospective multicenter cohort of 266 men with National Comprehensive Cancer Network (NCCN) very low/low and favorable-intermediate risk prostate cancer. Decipher and Cancer of the Prostate Risk Assessment (CAPRA) were compared as predictors of adverse pathology (AP) for which there is universal agreement that patients with long life-expectancy are not suitable candidates for AS (primary pattern 4 or 5, advanced local stage [pT3b or greater] or lymph node involvement). RESULTS: Decipher from prostatectomies was significantly associated with adverse pathologic features (p-values < 0.001). Decipher from the 266 diagnostic biopsies (64.7% NCCN-very-low/low and 35.3% favorable-intermediate) was an independent predictor of AP (odds ratio 1.29 per 10% increase, 95% confidence interval [CI] 1.03–1.61, p-value 0.025) when adjusting for CAPRA. CAPRA area under curve (AUC) was 0.57, (95% CI 0.47–0.68). Adding Decipher to CAPRA increased the AUC to 0.65 (95% CI 0.58–0.70). NPV, which determines the degree of confidence in the absence of AP for patients, was 91% (95% CI 87–94%) and 96% (95% CI 90–99%) for Decipher thresholds of 0.45 and 0.2, respectively. Using a threshold of 0.2, Decipher was a significant predictor of AP when adjusting for CAPRA (p-value 0.016). CONCLUSION: Decipher can be applied to prostate biopsies from NCCN-very-low/low and favorable-intermediate risk patients to predict absence of adverse pathologic features. These patients are predicted to be good candidates for active surveillance. Nature Publishing Group UK 2018-12-12 2019 /pmc/articles/PMC6760567/ /pubmed/30542054 http://dx.doi.org/10.1038/s41391-018-0101-6 Text en © The Author(s) 2018 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Article Kim, Hyung L. Li, Ping Huang, Huei-Chung Deheshi, Samineh Marti, Tara Knudsen, Beatrice Abou-Ouf, Hatem Alam, Ridwan Lotan, Tamara L. Lam, Lucia L. C. du Plessis, Marguerite Davicioni, Elai Fleshner, Neil Lane, Brian R. Ross, Ashley E. Davis, John W. Mohler, James L. Trock, Bruce J. Klein, Eric A. Tosoian, Jeffrey J. Hyndman, M. Eric Bismar, Tarek A. Validation of the Decipher Test for predicting adverse pathology in candidates for prostate cancer active surveillance |
title | Validation of the Decipher Test for predicting adverse pathology in candidates for prostate cancer active surveillance |
title_full | Validation of the Decipher Test for predicting adverse pathology in candidates for prostate cancer active surveillance |
title_fullStr | Validation of the Decipher Test for predicting adverse pathology in candidates for prostate cancer active surveillance |
title_full_unstemmed | Validation of the Decipher Test for predicting adverse pathology in candidates for prostate cancer active surveillance |
title_short | Validation of the Decipher Test for predicting adverse pathology in candidates for prostate cancer active surveillance |
title_sort | validation of the decipher test for predicting adverse pathology in candidates for prostate cancer active surveillance |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6760567/ https://www.ncbi.nlm.nih.gov/pubmed/30542054 http://dx.doi.org/10.1038/s41391-018-0101-6 |
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