MP64-12 ASSESSING DECIPHER FOR PREDICTING LYMPH NODE POSITIVE DISEASE AMONG MEN DIAGNOSED WITH INTERMEDIATE RISK DISEASE TREATED WITH PROSTATECTOMY AND EPLND

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V1 Apr 2017MP64-12 ASSESSING DECIPHER FOR PREDICTING LYMPH NODE POSITIVE DISEASE AMONG MEN DIAGNOSED WITH INTERMEDIATE RISK DISEASE TREATED WITH PROSTATECTOMY AND EPLND Mary Achim, Surena Matin, Brian Chapin, Patricia Troncoso, Elsa Li Ning Tapia, Mireya Guerrero, Ina Prokhorova, Anders Olson, Zaid Haddad, Jennifer Margrave, Jijumon Chelliserry, Lucia Lam, Kasra Yousefi, Christine Buerki, Elai Davicioni, and John Davis Mary AchimMary Achim More articles by this author , Surena MatinSurena Matin More articles by this author , Brian ChapinBrian Chapin More articles by this author , Patricia TroncosoPatricia Troncoso More articles by this author , Elsa Li Ning TapiaElsa Li Ning Tapia More articles by this author , Mireya GuerreroMireya Guerrero More articles by this author , Ina ProkhorovaIna Prokhorova More articles by this author , Anders OlsonAnders Olson More articles by this author , Zaid HaddadZaid Haddad More articles by this author , Jennifer MargraveJennifer Margrave More articles by this author , Jijumon ChelliserryJijumon Chelliserry More articles by this author , Lucia LamLucia Lam More articles by this author , Kasra YousefiKasra Yousefi More articles by this author , Christine BuerkiChristine Buerki More articles by this author , Elai DavicioniElai Davicioni More articles by this author , and John DavisJohn Davis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1985AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical prostatectomy (RP) is a primary treatment option for men with intermediate risk (IR) prostate cancer (PCa). Though many will be effectively cured with local therapy alone, these men are by definition at higher risk of disease recurrence. In this study, we evaluated whether a genomic signature of metastasis risk (Decipher PCa classifier) could improve pre-operative staging for predicting lymph node invasion (LNI). METHODS We examined 263 NCCN intermediate men treated with RP and extended template pelvic lymph node dissection (ePLND) from 2007-2015 at MD Anderson Cancer Center, Houston, Texas. Patients were categorized into three risk groups: 1) men with N1 disease (N1), 2) men without N0, but who had either ≥pT3 stage, RP Gleason score ≥8, lymphovascular invasion or tertiary Gleason 5 pattern (N0 high-risk [HR]) and 3) men with no high-risk features at RP (N0IR). Decipher scores were obtained from 263 RP specimens and 25 matching biopsy specimens. Fisher's exact test was used to compare the difference in patient risk groups. Logistic regression analysis was used to evaluate performance of Decipher for prediction of LNI. Discrimination of the Partin tables (≥2%) and combined model of Partin tables (≥2%) and Decipher (>0.6) was assessed using c-index. Concordance of biopsy and RP Decipher (low- and intermediate- vs high-risk) was also assessed. RESULTS Of the 263 men, 42 (16.0%), 98 (37.2%) and 123 (46.8%) men were categorized as N1, N0HR and N0IR risk groups, respectively. Partin tables classified 34/42 (81%) N1, 70/98 (71%) N0HR and 66/123 (54%) N0IR men as high clinical risk (≥2%) for LNI (p=0.0012). Decipher classified 23/42 (55%) N1, 34/98 (35%) N0HR and 35/123 (29%) N0IR as high genomic risk (>0.6) for metastasis (p=0.013). After adjusting for Partin Tables, Decipher high genomic risk had an odds ratio of 2.3 (95% CI 1.2-4.5) as a predictor of LNI (p=0.02). Addition of Decipher to Partin Tables improved the c-index from 0.60 (95%CI 0.53-0.67) to 0.66 (95%CI 0.57-0.75). The concordance of Decipher risk groups between matched Biopsy and RP specimens was 84%. CONCLUSIONS Decipher may be an important adjunct tool to improve preoperative staging that may be useful for prioritizing intermediate risk patients to ePLND. Further investigation of Decipher biopsy specimens is required to validate these findings. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e848-e849 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Mary Achim More articles by this author Surena Matin More articles by this author Brian Chapin More articles by this author Patricia Troncoso More articles by this author Elsa Li Ning Tapia More articles by this author Mireya Guerrero More articles by this author Ina Prokhorova More articles by this author Anders Olson More articles by this author Zaid Haddad More articles by this author Jennifer Margrave More articles by this author Jijumon Chelliserry More articles by this author Lucia Lam More articles by this author Kasra Yousefi More articles by this author Christine Buerki More articles by this author Elai Davicioni More articles by this author John Davis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...