MP79-01 VALIDATION OF A GENOMIC CLASSIFIER FOR PREDICTING CLINICAL PROGRESSION FOLLOWING POST-OPERATIVE RADIATION THERAPY IN HIGH-RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Markers II1 Apr 2014MP79-01 VALIDATION OF A GENOMIC CLASSIFIER FOR PREDICTING CLINICAL PROGRESSION FOLLOWING POST-OPERATIVE RADIATION THERAPY IN HIGH-RISK PROSTATE CANCER Edouard Trabulsi, Jeffrey Karnes, Felix Feng, Timothy Showalter, Mark Mishra, Costas Lallas, Leonard Gomella, Ruth Birbe, Peter McCue, Mercedeh Ghadessi, Christine Buerki, Elai Davicioni, Karen Knudsen, Adam Dicker, and Robert Den Edouard TrabulsiEdouard Trabulsi More articles by this author , Jeffrey KarnesJeffrey Karnes More articles by this author , Felix FengFelix Feng More articles by this author , Timothy ShowalterTimothy Showalter More articles by this author , Mark MishraMark Mishra More articles by this author , Costas LallasCostas Lallas More articles by this author , Leonard GomellaLeonard Gomella More articles by this author , Ruth BirbeRuth Birbe More articles by this author , Peter McCuePeter McCue More articles by this author , Mercedeh GhadessiMercedeh Ghadessi More articles by this author , Christine BuerkiChristine Buerki More articles by this author , Elai DavicioniElai Davicioni More articles by this author , Karen KnudsenKaren Knudsen More articles by this author , Adam DickerAdam Dicker More articles by this author , and Robert DenRobert Den More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2504AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radiation therapy (RT) is commonly offered in the post radical prostatectomy (RP) setting, however response varies. We hypothesized that the genomic classifier (GC; DecipherTM) score would predict clinical progression in men receiving post−RP RT. METHODS GC scores were available for analysis from two cohorts of post-RP RT patients treated at Thomas Jefferson University between 1990-2009 (TJU, n=139) and Mayo Clinic between 2000-2006 (Mayo, n=73). In the TJU cohort, biochemical failure (BF) and distant metastasis (DM) endpoints were evaluated. In the Mayo cohort, regional and distant (positive CT and/or bone scan) clinical metastasis (CM) was evaluated. Area under the receiver operating curve (AUC and Survival AUC), decision curves, cumulative incidence accounting for competing risks, and multivariable Cox regression analyses were used to assess GC for predicting BF, CM and DM. RESULTS In the TJU cohort, the AUC of CAPRA-S was 0.67 (95% CI 0.58−0.77) and 0.65 (95% CI 0.44−0.86) for BF and DM, respectively. Integration of GC improved AUC to 0.75 (95% CI 0.66−0.84) and 0.77 (95% CI 0.64−0.91) for BF and DM, respectively. In the Mayo cohort the AUC for GC was 0.78 (95% CI 0.66-0.85) for CM. In TJU, cumulative incidence of BF at 6 years post-RT was 21%, 40%, and 63% for low (<0.4), intermediate (0.4−0.6), and high (>0.6) GC (p<0.00001). Cumulative incidence of CM at 6 years post-RT in Mayo was 6.5%, 15% and 38% (p<0.0002). In both cohorts univariable analysis showed GC to be the most significant predictor of clinical progression after RT. In a multivariable model factoring GC, CAPRA-S and concurrent hormone therapy, TJU patients with high GC had an HR of 7.1 for BF (95% CI 3.2−15.9, p<2e-6). While, a similar trend was observed in Mayo, where patients with high GC had an HR of 2.1 for CM, this did not achieve significance (p=0.3). CONCLUSIONS In the post−RP RT setting, GC predicted treatment failure and demonstrated improved risk stratification above clinical classifiers in two independent cohorts. Patients with high GC score were at significantly higher risk for clinical progression after post-RP RT. For these patients, further exploration of benefit from systemic therapy is warranted. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e930 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Edouard Trabulsi More articles by this author Jeffrey Karnes More articles by this author Felix Feng More articles by this author Timothy Showalter More articles by this author Mark Mishra More articles by this author Costas Lallas More articles by this author Leonard Gomella More articles by this author Ruth Birbe More articles by this author Peter McCue More articles by this author Mercedeh Ghadessi More articles by this author Christine Buerki More articles by this author Elai Davicioni More articles by this author Karen Knudsen More articles by this author Adam Dicker More articles by this author Robert Den More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...