Sophie M Bruinsma1, Daan Nieboer1,2, Monique J Roobol1, Chris H Bangma1, Jan F M Verbeek1, Vincent Gnanapragasam3, Mieke Van Hemelrijck4, Mark Frydenberg5,6, Lui-Shiong Lee7,8, Riccardo Valdagni9, Christopher Logothetis10, Ewout W Steyerberg2,11. 1. Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands. 2. Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. 3. Academic Urology Group, Department of Surgery & Oncology, University of Cambridge, Cambridge, United Kingdom. 4. Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom. 5. Department of Urology, Cabrini Institute, Cabrini Health, Melbourne, Australia. 6. Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia. 7. Department of Urology, Sengkang General Hospital, Singapore, Singapore. 8. Department of Urology, Singapore General Hospital, Singapore, Singapore. 9. Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Prostate Cancer Program, Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. 10. MD Anderson Cancer Centre, Houston, Texas. 11. Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
PURPOSE: We sought to identify and validate known predictors of disease reclassification at 1 or 4 years to support risk-based selection of patients suitable for active surveillance. MATERIALS AND METHODS: An individual participant data meta-analysis using data from 25 established cohorts within the Movember Foundations GAP3 Consortium. In total 5,530 men were included. Disease reclassification was defined as any increase in Gleason grade group at biopsy at 1 and 4 years. Associations were estimated using random effect logistic regression models. The discriminative ability of combinations of predictors was assessed in an internal-external validation procedure using the AUC curve. RESULTS: Among the 5,570 men evaluated at 1 year, we found 815 reclassifications to higher Gleason grade group at biopsy (pooled reclassification rate 13%, range 0% to 31%). Important predictors were age, prostate specific antigen, prostate volume, T-stage and number of biopsy cores with prostate cancer. Among the 1,515 men evaluated at 4 years, we found 205 reclassifications (pooled reclassification rates 14%, range 3% to 40%), with similar predictors. The average areas under the receiver operating characteristic curve at internal-external validation were 0.68 and 0.61 for 1-year and 4-year reclassification, respectively. CONCLUSIONS: Disease reclassification occurs typically in 13% to 14% of biopsies at 1 and 4 years after the start of active surveillance with substantial between-study heterogeneity. Current guidelines might be extended by considering prostate volume to improve individualized selection for active surveillance. Additional predictors are needed to improve patient selection for active surveillance.
PURPOSE: We sought to identify and validate known predictors of disease reclassification at 1 or 4 years to support risk-based selection of patients suitable for active surveillance. MATERIALS AND METHODS: An individual participant data meta-analysis using data from 25 established cohorts within the Movember Foundations GAP3 Consortium. In total 5,530 men were included. Disease reclassification was defined as any increase in Gleason grade group at biopsy at 1 and 4 years. Associations were estimated using random effect logistic regression models. The discriminative ability of combinations of predictors was assessed in an internal-external validation procedure using the AUC curve. RESULTS: Among the 5,570 men evaluated at 1 year, we found 815 reclassifications to higher Gleason grade group at biopsy (pooled reclassification rate 13%, range 0% to 31%). Important predictors were age, prostate specific antigen, prostate volume, T-stage and number of biopsy cores with prostate cancer. Among the 1,515 men evaluated at 4 years, we found 205 reclassifications (pooled reclassification rates 14%, range 3% to 40%), with similar predictors. The average areas under the receiver operating characteristic curve at internal-external validation were 0.68 and 0.61 for 1-year and 4-year reclassification, respectively. CONCLUSIONS: Disease reclassification occurs typically in 13% to 14% of biopsies at 1 and 4 years after the start of active surveillance with substantial between-study heterogeneity. Current guidelines might be extended by considering prostate volume to improve individualized selection for active surveillance. Additional predictors are needed to improve patient selection for active surveillance.
Authors: Karolina Cyll; Sven Löffeler; Birgitte Carlsen; Karin Skogstad; May Lisbeth Plathan; Martin Landquist; Erik Skaaheim Haug Journal: Sci Rep Date: 2022-04-25 Impact factor: 4.996
Authors: Sarah Hagmann; Venkat Ramakrishnan; Alexander Tamalunas; Marc Hofmann; Moritz Vandenhirtz; Silvan Vollmer; Jsmea Hug; Philipp Niggli; Antonio Nocito; Rahel A Kubik-Huch; Kurt Lehmann; Lukas John Hefermehl Journal: Cancers (Basel) Date: 2022-01-12 Impact factor: 6.639