Preoperative Risk-Stratification of High-Risk Prostate Cancer: A Multicenter Analysis

TY - JOUR

T1 - Preoperative Risk-Stratification of High-Risk Prostate Cancer: 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 - 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

Y1 - 2020

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.

U2 - 10.3389/fonc.2020.00246

DO - 10.3389/fonc.2020.00246

M3 - SCORING: Journal article

C2 - 32211317

VL - 10

SP - 246

JO - FRONT ONCOL

JF - FRONT ONCOL

SN - 2234-943X

ER -