Yu Fan1,2,3,4, Yelin Mulati1,2,3, Lingyun Zhai5, Yuke Chen1,2,3, Yu Wang1,2,3, Juefei Feng6, Wei Yu1,2,3, Qian Zhang1,2,3,7. 1. Department of Urology, Peking University First Hospital, Beijing, China. 2. Institute of Urology, Peking University, Beijing, China. 3. National Urological Cancer Center, Beijing, China. 4. Department of Urology, Tibet Autonomous Region People's Hospital, Lhasa, China. 5. Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. 6. Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore. 7. Peking University Binhai Hospital, Tianjin, China.
Abstract
BACKGROUND: Several active surveillance (AS) criteria have been established to screen insignificant prostate cancer (insigPCa, defined as organ confined, low grade and small volume tumors confirmed by postoperative pathology). However, their comparative diagnostic performance varies. The aim of this study was to compare the diagnostic accuracy of contemporary AS criteria and validate the absolute diagnostic odds ratio (DOR) of optimal AS criteria. METHODS: First, we searched Pubmed and performed a Bayesian network meta-analysis (NMA) to compare the diagnostic accuracy of contemporary AS criteria and obtained a relative ranking. Then, we searched Pubmed again to perform another meta-analysis to validate the absolute DOR of the top-ranked AS criteria derived from the NMA with two endpoints: insigPCa and favorable disease (defined as organ confined, low grade tumors). Subgroup and meta-regression analyses were conducted to identify any potential heterogeneity in the results. Publication bias was evaluated. RESULTS: Seven eligible retrospective studies with 3,336 participants were identified for the NMA. The diagnostic accuracy of AS criteria ranked from best to worst, was as follows: Epstein Criteria (EC), Yonsei criteria, Prostate Cancer Research International: Active Surveillance (PRIAS), University of Miami (UM), University of California-San Francisco (UCSF), Memorial Sloan-Kettering Cancer Center (MSKCC), and University of Toronto (UT). I2 = 50.5%, and sensitivity analysis with different insigPCa definitions supported the robustness of the results. In the subsequent meta-analysis of DOR of EC, insigPCa and favorable disease were identified as endpoints in ten and twenty-two studies, respectively. The pooled DOR for insigPCa and favorable disease were 0.44 (95%CI, 0.31-0.58) and 0.66 (95%CI, 0.61-0.71), respectively. According to a subgroup analysis, the DOR for favorable disease was significantly higher in US institutions than that in other regions. No significant heterogeneity or evidence of publication bias was identified. CONCLUSIONS: Among the seven AS criteria evaluated in this study, EC was optimal for positively identifying insigPCa patients. The pooled diagnostic accuracy of EC was 0.44 for insigPCa and 0.66 when a more liberal endpoint, favorable disease, was used. SYSTEMATIC REVIEW REGISTRATION: [https://www.crd.york.ac.uk/prospero/], PROSPERO [CRD42020157048].
BACKGROUND: Several active surveillance (AS) criteria have been established to screen insignificant prostate cancer (insigPCa, defined as organ confined, low grade and small volume tumors confirmed by postoperative pathology). However, their comparative diagnostic performance varies. The aim of this study was to compare the diagnostic accuracy of contemporary AS criteria and validate the absolute diagnostic odds ratio (DOR) of optimal AS criteria. METHODS: First, we searched Pubmed and performed a Bayesian network meta-analysis (NMA) to compare the diagnostic accuracy of contemporary AS criteria and obtained a relative ranking. Then, we searched Pubmed again to perform another meta-analysis to validate the absolute DOR of the top-ranked AS criteria derived from the NMA with two endpoints: insigPCa and favorable disease (defined as organ confined, low grade tumors). Subgroup and meta-regression analyses were conducted to identify any potential heterogeneity in the results. Publication bias was evaluated. RESULTS: Seven eligible retrospective studies with 3,336 participants were identified for the NMA. The diagnostic accuracy of AS criteria ranked from best to worst, was as follows: Epstein Criteria (EC), Yonsei criteria, Prostate Cancer Research International: Active Surveillance (PRIAS), University of Miami (UM), University of California-San Francisco (UCSF), Memorial Sloan-Kettering Cancer Center (MSKCC), and University of Toronto (UT). I2 = 50.5%, and sensitivity analysis with different insigPCa definitions supported the robustness of the results. In the subsequent meta-analysis of DOR of EC, insigPCa and favorable disease were identified as endpoints in ten and twenty-two studies, respectively. The pooled DOR for insigPCa and favorable disease were 0.44 (95%CI, 0.31-0.58) and 0.66 (95%CI, 0.61-0.71), respectively. According to a subgroup analysis, the DOR for favorable disease was significantly higher in US institutions than that in other regions. No significant heterogeneity or evidence of publication bias was identified. CONCLUSIONS: Among the seven AS criteria evaluated in this study, EC was optimal for positively identifying insigPCa patients. The pooled diagnostic accuracy of EC was 0.44 for insigPCa and 0.66 when a more liberal endpoint, favorable disease, was used. SYSTEMATIC REVIEW REGISTRATION: [https://www.crd.york.ac.uk/prospero/], PROSPERO [CRD42020157048].
Authors: Oleksandr N Kryvenko; Kirill Lyapichev; Felix M Chinea; Nachiketh Soodana Prakash; Alan Pollack; Mark L Gonzalgo; Sanoj Punnen; Merce Jorda Journal: Am J Surg Pathol Date: 2016-08 Impact factor: 6.394
Authors: Ari Adamy; David S Yee; Kazuhito Matsushita; Alexandra Maschino; Angel Cronin; Andrew Vickers; Bertrand Guillonneau; Peter T Scardino; James A Eastham Journal: J Urol Date: 2010-12-17 Impact factor: 7.450
Authors: Sang E Lee; Dae S Kim; Won K Lee; Hong Z Park; Chang J Lee; Seung H Doo; Seong J Jeong; Cheol Y Yoon; Seok-Soo Byun; Gheeyoung Choe; Sung I Hwang; Hak J Lee; Sung K Hong Journal: BJU Int Date: 2009-11-13 Impact factor: 5.588
Authors: Freddie Bray; Jacques Ferlay; Isabelle Soerjomataram; Rebecca L Siegel; Lindsey A Torre; Ahmedin Jemal Journal: CA Cancer J Clin Date: 2018-09-12 Impact factor: 508.702
Authors: Martin G Sanda; Jeffrey A Cadeddu; Erin Kirkby; Ronald C Chen; Tony Crispino; Joann Fontanarosa; Stephen J Freedland; Kirsten Greene; Laurence H Klotz; Danil V Makarov; Joel B Nelson; George Rodrigues; Howard M Sandler; Mary Ellen Taplin; Jonathan R Treadwell Journal: J Urol Date: 2017-12-15 Impact factor: 7.450
Authors: Seol Ho Choo; Hwang Gyun Jeon; Byong Chang Jeong; Seong Il Seo; Seong Soo Jeon; Han Yong Choi; Hyun Moo Lee Journal: Prostate Int Date: 2014-06-30