To analyze the performance of the Prostate Health Index(phi)and its derivatives for predicting Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the Chinese population,an observational...To analyze the performance of the Prostate Health Index(phi)and its derivatives for predicting Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the Chinese population,an observational,prospective RP cohort consisting of 351 patients from two medical centers was established from January 2017 to September 2020.Pathological reclassification was determined by the Gleason Grade Group(GG).The area under the receiver operating characteristic curve(AUC)and logistic regression(LR)models were used to evaluate the predictive performance of predictors.In clinically low-risk patients with biopsy GG≤2,phi(odds ratio[OR]=1.80,95%confidence interval[95%CI]:1.14-2.82,P=0.01)and its derivative phi density(PHID;OR=2.34,95%CI:1.30-4.20,P=0.005)were significantly associated with upgrading to GG≥3 after RP,and the results were confirmed by multivariable analysis.Similar results were observed in patients with biopsy GG of 1 for the prediction of upgrading to RP GG≥2.Compared to the base model(AUC=0.59),addition of the phi or PHID could provide additional predictive value for GS upgrading in low-risk patients(AUC=0.69 and 0.71,respectively,both P<0.05).In conclusion,phi and PHID could predict GS upgrading after RP in clinically low-risk patients.展开更多
Eastern Cooperative Oncology Group(ECOG)performance status and Gleason score are commonly investigated factors for overall survival(OS)in men with castration-resistant prostate cancer(CRPC).However,there is a lack of ...Eastern Cooperative Oncology Group(ECOG)performance status and Gleason score are commonly investigated factors for overall survival(OS)in men with castration-resistant prostate cancer(CRPC).However,there is a lack of consistency regarding their prognostic or predictive value for OS.Therefore,we performed this meta-analysis to assess the associations of ECOG performance status and Gleason score with OS in CRPC patients and compare the two markers in patients under different treatment regimens or with different chemotherapy histories.A systematic literature review of monotherapy studies in CRPC patients was conducted in the PubMed database until May 2019.The data from 8247 patients in 34 studies,including clinical trials and real-world data,were included in our meta-analysis.Of these,twenty studies reported multivariate results and were included in our main analysis.CRPC patients with higher ECOG performance statuses(≥2)had a significantly increased mortality risk than those with lower ECOG performance statuses(<2),hazard ratio(HR):2.10,95%confidence interval(CI):1.68-2.62,and P<0.001.The synthesized HR of OS stratified by Gleason score was 1.01,with a 95%CI of 0.62-1.67(Gleason score≥8 vs<8).Subgroup analysis showed that there was no significant difference in pooled HRs for patients administered taxane chemotherapy(docetaxel and cabazitaxel)and androgen-targeting therapy(abiraterone acetate and enzalutamide)or for patients with different chemotherapy histories.ECOG performance status was identified as a significant prognostic factor in CRPC patients,while Gleason score showed a weak prognostic value for OS based on the available data in our meta-analysis.展开更多
We aimed to compare Gleason score and tumor laterality between transrectal ultrasound-guided biopsy of the prostate （TRUSBX） and radical prostatectomy （RP）. Some factors that could cause a discrepancy in results b...We aimed to compare Gleason score and tumor laterality between transrectal ultrasound-guided biopsy of the prostate （TRUSBX） and radical prostatectomy （RP）. Some factors that could cause a discrepancy in results between these two procedures were also evaluated. Among the 318 cases reviewed, 191 cases were selected for inclusion in this comparative Study, We divided the patients into two groups using the Gleason score： an intermediate/high-grade group （≥7） and a low-grade group （〈6）. Exploratory analyses were conducted for comparisons between groups. We also performed comparisons between TRUSBX and RP for tumor laterality. TRUSBX overestimated 6% and underestimated 24% cases in comparison with RP for Gleason score, and overestimated 2.6% and underestimated 46% cases compared with RP for tumor laterality. Biopsy specimens were slightly smaller in TRUSBX cases with underestimated tumor laterality （P〈 0.05）, and no relationship between the biopsy specimen size and underestimated Gleason score in TRUSBX was found. Prostatic volume showed no statistical correlation with the likelihood of under or overestimation （P 〉 0.05）. Thus, our study showed that TRUSBX has a high likelihood of underestimating both the Gleason score and tumor laterality in prostate cancer （PCa）. The size of the fragment appears to be an important factor influencing the likelihood of laterality underestimation and Gleason score overestimation via TRUSBX. Due to the high likelihood of underestimation of the Gleason score and tumor laterality by 12-core prostate biopsy, we conclude that this type of biopsy should not be used alone to guide therapy in Pca.展开更多
The circadian clock is strongly influenced by the sun exposure and prostate cancer has been shown to be inversely proportional to it.We investigated whether PCa aggressiveness in Montreal,Quebec,Canada,differs over th...The circadian clock is strongly influenced by the sun exposure and prostate cancer has been shown to be inversely proportional to it.We investigated whether PCa aggressiveness in Montreal,Quebec,Canada,differs over the months during or following potentially longer exposure to sunlight.We analyzed 3447 patients treated between January 1995 and December 2023 with primary radiotherapy for localized PCa.We investigated whether the month when diagnostic biopsy was performed was associated with a more frequent diagnosis of a primary Gleason score(pGS)of 4 or 5.We grouped the months of biopsy into the four quarters(Q1–4)of the year.Multivariable logistic regression was used to predict a pGS of 4 or 5,adjusted for age and year of biopsy.There were significantly fewer biopsies(P=0.027)with pGS 4 or 5 in the last 3 months of the year(Q4;19.0%)than those in Q1–3(22.9%).Age,prostate-specific antigen(PSA)level,and the number of positive biopsies were not significantly different between Q4 versus Q1–3.In multivariate logistic regression analysis,a biopsy in Q4 was significantly predictive of a lower risk of pGS 4 or 5(odds ratio[OR]:0.77,95%confidence interval[CI]:0.63–0.93,P=0.007),as was older age(P<0.001),but not the year of biopsy(P=0.76).In conclusion,patients biopsied during Q4 had a 23%lower risk of a pGS 4 or 5 on diagnostic biopsy than those biopsied during the previous 9 months.Our results are not a proof of causality.展开更多
目的研究前列腺癌磁共振扩散张量成像(DTI)参数表观扩散系数(ADC)与各向异性分数(FA)与其病理分级(Gleason评分)的关系,评价ADC值与FA值对于前列腺癌病理分级的诊断价值及评价前列腺癌危险度分级的诊断效能。方法采用3.0 T MR对70例经...目的研究前列腺癌磁共振扩散张量成像(DTI)参数表观扩散系数(ADC)与各向异性分数(FA)与其病理分级(Gleason评分)的关系,评价ADC值与FA值对于前列腺癌病理分级的诊断价值及评价前列腺癌危险度分级的诊断效能。方法采用3.0 T MR对70例经病理证实的前列腺癌患者行DTI检查,b值为0和800 s/mm2。测量前列腺癌的ADC值及FA值,根据病理结果将患者按Gleason评分系统分为高、中、低危三组:Gleason≥8分、Gleason=7分、Gleason≤6分。对三组数据进行单因素方差分析(one-way ANOVA),并进行组间两两比较。采用Pearson相关分析检验前列腺癌ADC值及FA值与Gleason评分的相关性。将前列腺癌Gleason评分≤7与Gleason评分≥8两组之间进行受试者工作特性(ROC)曲线分析,判断低中危组与高危组诊断界值。结果三组前列腺癌区平均ADC值分别为(0.96±0.10)×10-3mm2/s、(0.76±0.15)×10-3mm2/s和(0.62±0.12)×10-3mm2/s,FA值分别为0.39±0.06、0.31±0.09和0.22±0.06;三组ADC值、FA值组间差异均具有统计学意义(P<0.05);ADC值、FA值与Gleason评分之间均呈负相关(ADC值r=-0.768,P<0.05;FA值r=-0.662,P<0.05),两者均随Gleason评分的增高而减小。以ADC=0.68×10-3mm2/s为临界点,区分低中危组与高危组癌灶的诊断敏感性84.2%,特异性76.9%,准确性87.1%;以FA=0.24为临界点,区分低中危组与高危组癌灶的诊断敏感性79.5%,特异性75.8%,准确性78.4%。结论前列腺癌ADC值及FA值与病理分级(Gleason评分)之间呈负相关,具有预测癌灶恶性程度的潜力,有助于预测前列腺癌的恶性程度。展开更多
基金supported by grants from the National Natural Science Foundation of China(No.81772741 and No.81972645),Shanghai Jiao Tong University School of Medicine Gaofeng-Clinical Medicine Grant Support(No.20181701)Shanghai Municipal Human Resources and Social Security Bureau(No.2018052)to RNthe Clinical Research Project of Shanghai Health Commission(No.20214Y0511)to YSW.
文摘To analyze the performance of the Prostate Health Index(phi)and its derivatives for predicting Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the Chinese population,an observational,prospective RP cohort consisting of 351 patients from two medical centers was established from January 2017 to September 2020.Pathological reclassification was determined by the Gleason Grade Group(GG).The area under the receiver operating characteristic curve(AUC)and logistic regression(LR)models were used to evaluate the predictive performance of predictors.In clinically low-risk patients with biopsy GG≤2,phi(odds ratio[OR]=1.80,95%confidence interval[95%CI]:1.14-2.82,P=0.01)and its derivative phi density(PHID;OR=2.34,95%CI:1.30-4.20,P=0.005)were significantly associated with upgrading to GG≥3 after RP,and the results were confirmed by multivariable analysis.Similar results were observed in patients with biopsy GG of 1 for the prediction of upgrading to RP GG≥2.Compared to the base model(AUC=0.59),addition of the phi or PHID could provide additional predictive value for GS upgrading in low-risk patients(AUC=0.69 and 0.71,respectively,both P<0.05).In conclusion,phi and PHID could predict GS upgrading after RP in clinically low-risk patients.
文摘Eastern Cooperative Oncology Group(ECOG)performance status and Gleason score are commonly investigated factors for overall survival(OS)in men with castration-resistant prostate cancer(CRPC).However,there is a lack of consistency regarding their prognostic or predictive value for OS.Therefore,we performed this meta-analysis to assess the associations of ECOG performance status and Gleason score with OS in CRPC patients and compare the two markers in patients under different treatment regimens or with different chemotherapy histories.A systematic literature review of monotherapy studies in CRPC patients was conducted in the PubMed database until May 2019.The data from 8247 patients in 34 studies,including clinical trials and real-world data,were included in our meta-analysis.Of these,twenty studies reported multivariate results and were included in our main analysis.CRPC patients with higher ECOG performance statuses(≥2)had a significantly increased mortality risk than those with lower ECOG performance statuses(<2),hazard ratio(HR):2.10,95%confidence interval(CI):1.68-2.62,and P<0.001.The synthesized HR of OS stratified by Gleason score was 1.01,with a 95%CI of 0.62-1.67(Gleason score≥8 vs<8).Subgroup analysis showed that there was no significant difference in pooled HRs for patients administered taxane chemotherapy(docetaxel and cabazitaxel)and androgen-targeting therapy(abiraterone acetate and enzalutamide)or for patients with different chemotherapy histories.ECOG performance status was identified as a significant prognostic factor in CRPC patients,while Gleason score showed a weak prognostic value for OS based on the available data in our meta-analysis.
文摘We aimed to compare Gleason score and tumor laterality between transrectal ultrasound-guided biopsy of the prostate （TRUSBX） and radical prostatectomy （RP）. Some factors that could cause a discrepancy in results between these two procedures were also evaluated. Among the 318 cases reviewed, 191 cases were selected for inclusion in this comparative Study, We divided the patients into two groups using the Gleason score： an intermediate/high-grade group （≥7） and a low-grade group （〈6）. Exploratory analyses were conducted for comparisons between groups. We also performed comparisons between TRUSBX and RP for tumor laterality. TRUSBX overestimated 6% and underestimated 24% cases in comparison with RP for Gleason score, and overestimated 2.6% and underestimated 46% cases compared with RP for tumor laterality. Biopsy specimens were slightly smaller in TRUSBX cases with underestimated tumor laterality （P〈 0.05）, and no relationship between the biopsy specimen size and underestimated Gleason score in TRUSBX was found. Prostatic volume showed no statistical correlation with the likelihood of under or overestimation （P 〉 0.05）. Thus, our study showed that TRUSBX has a high likelihood of underestimating both the Gleason score and tumor laterality in prostate cancer （PCa）. The size of the fragment appears to be an important factor influencing the likelihood of laterality underestimation and Gleason score overestimation via TRUSBX. Due to the high likelihood of underestimation of the Gleason score and tumor laterality by 12-core prostate biopsy, we conclude that this type of biopsy should not be used alone to guide therapy in Pca.
文摘The circadian clock is strongly influenced by the sun exposure and prostate cancer has been shown to be inversely proportional to it.We investigated whether PCa aggressiveness in Montreal,Quebec,Canada,differs over the months during or following potentially longer exposure to sunlight.We analyzed 3447 patients treated between January 1995 and December 2023 with primary radiotherapy for localized PCa.We investigated whether the month when diagnostic biopsy was performed was associated with a more frequent diagnosis of a primary Gleason score(pGS)of 4 or 5.We grouped the months of biopsy into the four quarters(Q1–4)of the year.Multivariable logistic regression was used to predict a pGS of 4 or 5,adjusted for age and year of biopsy.There were significantly fewer biopsies(P=0.027)with pGS 4 or 5 in the last 3 months of the year(Q4;19.0%)than those in Q1–3(22.9%).Age,prostate-specific antigen(PSA)level,and the number of positive biopsies were not significantly different between Q4 versus Q1–3.In multivariate logistic regression analysis,a biopsy in Q4 was significantly predictive of a lower risk of pGS 4 or 5(odds ratio[OR]:0.77,95%confidence interval[CI]:0.63–0.93,P=0.007),as was older age(P<0.001),but not the year of biopsy(P=0.76).In conclusion,patients biopsied during Q4 had a 23%lower risk of a pGS 4 or 5 on diagnostic biopsy than those biopsied during the previous 9 months.Our results are not a proof of causality.
文摘目的研究前列腺癌磁共振扩散张量成像(DTI)参数表观扩散系数(ADC)与各向异性分数(FA)与其病理分级(Gleason评分)的关系,评价ADC值与FA值对于前列腺癌病理分级的诊断价值及评价前列腺癌危险度分级的诊断效能。方法采用3.0 T MR对70例经病理证实的前列腺癌患者行DTI检查,b值为0和800 s/mm2。测量前列腺癌的ADC值及FA值,根据病理结果将患者按Gleason评分系统分为高、中、低危三组:Gleason≥8分、Gleason=7分、Gleason≤6分。对三组数据进行单因素方差分析(one-way ANOVA),并进行组间两两比较。采用Pearson相关分析检验前列腺癌ADC值及FA值与Gleason评分的相关性。将前列腺癌Gleason评分≤7与Gleason评分≥8两组之间进行受试者工作特性(ROC)曲线分析,判断低中危组与高危组诊断界值。结果三组前列腺癌区平均ADC值分别为(0.96±0.10)×10-3mm2/s、(0.76±0.15)×10-3mm2/s和(0.62±0.12)×10-3mm2/s,FA值分别为0.39±0.06、0.31±0.09和0.22±0.06;三组ADC值、FA值组间差异均具有统计学意义(P<0.05);ADC值、FA值与Gleason评分之间均呈负相关(ADC值r=-0.768,P<0.05;FA值r=-0.662,P<0.05),两者均随Gleason评分的增高而减小。以ADC=0.68×10-3mm2/s为临界点,区分低中危组与高危组癌灶的诊断敏感性84.2%,特异性76.9%,准确性87.1%;以FA=0.24为临界点,区分低中危组与高危组癌灶的诊断敏感性79.5%,特异性75.8%,准确性78.4%。结论前列腺癌ADC值及FA值与病理分级(Gleason评分)之间呈负相关,具有预测癌灶恶性程度的潜力,有助于预测前列腺癌的恶性程度。
