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Validation of a genomic classifier for prediction of metastasis and prostate cancer-specific mortality in African-American men following radical prostatectomy in an equal access healthcare setting.

Publication ,  Journal Article
Howard, LE; Zhang, J; Fishbane, N; Hoedt, AMD; Klaassen, Z; Spratt, DE; Vidal, AC; Lin, D; Hitchins, MP; You, S; Freeman, MR; Yamoah, K ...
Published in: Prostate cancer and prostatic diseases
September 2020

The Decipher 22-gene genomic classifier (GC) may help in post-radical prostatectomy (RP) decision making given its superior prognostic performance over clinicopathologic variables alone. However, most studies evaluating the GC have had a modest representation of African-American men (AAM). We evaluated the GC within a large Veteran Affairs cohort and compared its performance to CAPRA-S for predicting outcomes in AAM and non-AAM after RP.GC scores were generated for 548 prostate cancer (PC) patients, who underwent RP at the Durham Veteran Affairs Medical Center between 1989 and 2016. This was a clinically high-risk cohort and was selected to have either pT3a, positive margins, seminal vesicle invasion, or received post-RP radiotherapy. Multivariable Cox models and survival C-indices were used to compare the performance of GC and CAPRA-S for predicting the risk of metastasis and PC-specific mortality (PCSM).Median follow-up was 9 years, during which 37 developed metastasis and 20 died from PC. Overall, 55% (n = 301) of patients were AAM. In multivariable analyses, GC (high vs. intermediate and intermediate vs. low) was a significant predictor of metastasis in all men (all p < 0.001). Consistent with prior studies, relative to CAPRA-S, GC had a higher C-index for 5-year metastasis (0.78 vs. 0.72) and 10-year PCSM (0.85 vs. 0.81). There was a suggestion GC was a stronger predictor in AAM than non-AAM. Specifically, the 5-year metastasis risk C-index was 0.86 in AAM vs. 0.69 in non-AAM and the 10-year PCSM risk C-index was 0.91 in AAM vs. 0.78 in non-AAM. However, the test for interaction of race and the performance of the GC in the Cox model was not significant for either metastasis or PCSM (both p ≥ 0.3).GC was a very strong predictor of poor outcome and performed well in both AAM and non-AAM. Our data support the use of GC for risk stratification in AAM post-RP. While our data suggest that GC may actually work better in AAM, given the limited number of events, further validation is needed.

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Published In

Prostate cancer and prostatic diseases

DOI

EISSN

1476-5608

ISSN

1365-7852

Publication Date

September 2020

Volume

23

Issue

3

Start / End Page

419 / 428

Related Subject Headings

  • White People
  • Urology & Nephrology
  • United States Department of Veterans Affairs
  • United States
  • Treatment Outcome
  • Survival Analysis
  • Risk Factors
  • Risk Assessment
  • Radiotherapy, Adjuvant
  • ROC Curve
 

Citation

APA
Chicago
ICMJE
MLA
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Howard, L. E., Zhang, J., Fishbane, N., Hoedt, A. M. D., Klaassen, Z., Spratt, D. E., … Freedland, S. J. (2020). Validation of a genomic classifier for prediction of metastasis and prostate cancer-specific mortality in African-American men following radical prostatectomy in an equal access healthcare setting. Prostate Cancer and Prostatic Diseases, 23(3), 419–428. https://doi.org/10.1038/s41391-019-0197-3
Howard, Lauren E., Jingbin Zhang, Nick Fishbane, Amanda M De Hoedt, Zachary Klaassen, Daniel E. Spratt, Adriana C. Vidal, et al. “Validation of a genomic classifier for prediction of metastasis and prostate cancer-specific mortality in African-American men following radical prostatectomy in an equal access healthcare setting.Prostate Cancer and Prostatic Diseases 23, no. 3 (September 2020): 419–28. https://doi.org/10.1038/s41391-019-0197-3.
Howard LE, Zhang J, Fishbane N, Hoedt AMD, Klaassen Z, Spratt DE, et al. Validation of a genomic classifier for prediction of metastasis and prostate cancer-specific mortality in African-American men following radical prostatectomy in an equal access healthcare setting. Prostate cancer and prostatic diseases. 2020 Sep;23(3):419–28.
Howard, Lauren E., et al. “Validation of a genomic classifier for prediction of metastasis and prostate cancer-specific mortality in African-American men following radical prostatectomy in an equal access healthcare setting.Prostate Cancer and Prostatic Diseases, vol. 23, no. 3, Sept. 2020, pp. 419–28. Epmc, doi:10.1038/s41391-019-0197-3.
Howard LE, Zhang J, Fishbane N, Hoedt AMD, Klaassen Z, Spratt DE, Vidal AC, Lin D, Hitchins MP, You S, Freeman MR, Yamoah K, Davicioni E, Freedland SJ. Validation of a genomic classifier for prediction of metastasis and prostate cancer-specific mortality in African-American men following radical prostatectomy in an equal access healthcare setting. Prostate cancer and prostatic diseases. 2020 Sep;23(3):419–428.

Published In

Prostate cancer and prostatic diseases

DOI

EISSN

1476-5608

ISSN

1365-7852

Publication Date

September 2020

Volume

23

Issue

3

Start / End Page

419 / 428

Related Subject Headings

  • White People
  • Urology & Nephrology
  • United States Department of Veterans Affairs
  • United States
  • Treatment Outcome
  • Survival Analysis
  • Risk Factors
  • Risk Assessment
  • Radiotherapy, Adjuvant
  • ROC Curve