Ability of a Genomic Classifier to Predict Metastasis and Prostate Cancer-specific Mortality after Radiation or Surgery based on Needle Biopsy Specimens

Paul L. Nguyen, Zaid Haddad, Ashley E. Ross, Neil E. Martin, Samineh Deheshi, Lucia L.C. Lam, Jijumon Chelliserry, Jeffrey J. Tosoian, Tamara L. Lotan, Daniel E. Spratt, Radka S. Stoyanova, Sanoj Punnen, Kaye Ong, Christine Buerki, Maria Aranes, Tyler Kolisnik, Jennifer Margrave, Kasra Yousefi, Voleak Choeurng, Elai DavicioniBruce J. Trock, Christopher J. Kane, Alan Pollack, John W. Davis, Felix Y. Feng, Eric A. Klein

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

Background Decipher is a validated genomic classifier developed to determine the biological potential for metastasis after radical prostatectomy (RP). Objective To evaluate the ability of biopsy Decipher to predict metastasis and Prostate cancer-specific mortality (PCSM) in primarily intermediate- to high-risk patients treated with RP or radiation therapy (RT). Design, setting, and participants Two hundred and thirty-five patients treated with either RP (n = 105) or RT ± androgen deprivation therapy (n = 130) with available genomic expression profiles generated from diagnostic biopsy specimens from seven tertiary referral centers. The highest-grade core was sampled and Decipher was calculated based on a locked random forest model. Outcome measurements and statistical analysis Metastasis and PCSM were the primary and secondary outcomes of the study, respectively. Cox analysis and c-index were used to evaluate the performance of Decipher. Results and limitations With a median follow-up of 6 yr among censored patients, 34 patients developed metastases and 11 died of prostate cancer. On multivariable analysis, biopsy Decipher remained a significant predictor of metastasis (hazard ratio: 1.37 per 10% increase in score, 95% confidence interval [CI]: 1.06–1.78, p = 0.018) after adjusting for clinical variables. For predicting metastasis 5-yr post-biopsy, Cancer of the Prostate Risk Assessment score had a c-index of 0.60 (95% CI: 0.50–0.69), while Cancer of the Prostate Risk Assessment plus biopsy Decipher had a c-index of 0.71 (95% CI: 0.60–0.82). National Comprehensive Cancer Network risk group had a c-index of 0.66 (95% CI: 0.53–0.77), while National Comprehensive Cancer Network plus biopsy Decipher had a c-index of 0.74 (95% CI: 0.66–0.82). Biopsy Decipher was a significant predictor of PCSM (hazard ratio: 1.57 per 10% increase in score, 95% CI: 1.03–2.48, p = 0.037), with a 5-yr PCSM rate of 0%, 0%, and 9.4% for Decipher low, intermediate, and high, respectively. Conclusions Biopsy Decipher predicted metastasis and PCSM from diagnostic biopsy specimens of primarily intermediate- and high-risk men treated with first-line RT or RP. Patient summary Biopsy Decipher predicted metastasis and prostate cancer-specific mortality risk from diagnostic biopsy specimens. Biopsy Decipher was able to predict metastasis and prostate cancer-specific mortality from diagnostic biopsy specimens in a cohort of primarily intermediate- and high-risk men regardless of type of first-line treatment.

Original languageEnglish (US)
Pages (from-to)845-852
Number of pages8
JournalEuropean urology
Volume72
Issue number5
DOIs
StatePublished - Nov 2017

Keywords

  • Biopsy
  • Genomics
  • Metastasis
  • Prostate cancer-specific mortality

ASJC Scopus subject areas

  • Urology

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    Nguyen, P. L., Haddad, Z., Ross, A. E., Martin, N. E., Deheshi, S., Lam, L. L. C., Chelliserry, J., Tosoian, J. J., Lotan, T. L., Spratt, D. E., Stoyanova, R. S., Punnen, S., Ong, K., Buerki, C., Aranes, M., Kolisnik, T., Margrave, J., Yousefi, K., Choeurng, V., ... Klein, E. A. (2017). Ability of a Genomic Classifier to Predict Metastasis and Prostate Cancer-specific Mortality after Radiation or Surgery based on Needle Biopsy Specimens. European urology, 72(5), 845-852. https://doi.org/10.1016/j.eururo.2017.05.009