A non-invasive 25-Gene PLNM-Score urine test for detection of prostate cancer pelvic lymph node metastasisUniv Hong Kong, Shenzhen Hosp, Shenzhen, Peoples R China..
Univ Hong Kong, Shenzhen Hosp, Shenzhen, Peoples R China..
Jinan Univ, Shenzhen Peoples Hosp, Clin Med Coll 2, Dept Urol, Shenzhen, Peoples R China.;Southern Univ Sci & Technol, Affiliated Hosp 1, Shenzhen Peoples Hosp, Shenzhen, Peoples R China..
Inst Basic Med Sci, Dept Biodiag, Beijing, Peoples R China..
First Peoples Hosp Foshan, Dept Urol, Foshan, Peoples R China..
Sun Yat Sen Univ, Affiliated Hosp 1, Dept Urol, Guangzhou, Peoples R China..
San Francisco Gen Hosp, Clin Labs, San Francisco, CA USA..
Kinet Real, Santa Clara, CA USA..
Lund Univ, Clin Res Ctr, Dept Translat Med, Malmö, Sweden..
Lund Univ, Clin Res Ctr, Dept Translat Med, Malmö, Sweden..
Inst Basic Med Sci, Dept Biodiag, Beijing, Peoples R China..
Sun Yat Sen Univ, Affiliated Hosp 1, Dept Urol, Guangzhou, Peoples R China..
Jinan Univ, Shenzhen Peoples Hosp, Clin Med Coll 2, Dept Urol, Shenzhen, Peoples R China.;Southern Univ Sci & Technol, Affiliated Hosp 1, Shenzhen Peoples Hosp, Shenzhen, Peoples R China..
Jinan Univ, Shenzhen Peoples Hosp, Clin Med Coll 2, Dept Urol, Shenzhen, Peoples R China.;Shenzhen Urol Minimally Invas Engn Ctr, Shenzhen, Peoples R China.;Jinan Univ, Shenzhen Peoples Hosp, Shenzhen Publ Serv Platform Tumor Precis Med & Mol, Clin Med Coll 2, Shenzhen, Peoples R China.;Southern Univ Sci & Technol, Affiliated Hosp 1, Shenzhen Peoples Hosp, Shenzhen, Peoples R China.;Southwest Med Univ, Sch Pharm, Key Lab Med Electrophysiol, Educ Minist, Luzhou, Peoples R China..
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2024 (English)In: Prostate Cancer and Prostatic Diseases, ISSN 1365-7852, E-ISSN 1476-5608Article in journal (Refereed) Epub ahead of print
Abstract [en]
Background: Prostate cancer patients with pelvic lymph node metastasis (PLNM) have poor prognosis. Based on EAU guidelines, patients with >5% risk of PLNM by nomograms often receive pelvic lymph node dissection (PLND) during prostatectomy. However, nomograms have limited accuracy, so large numbers of false positive patients receive unnecessary surgery with potentially serious side effects. It is important to accurately identify PLNM, yet current tests, including imaging tools are inaccurate. Therefore, we intended to develop a gene expression-based algorithm for detecting PLNM. Methods: An advanced random forest machine learning algorithm screening was conducted to develop a classifier for identifying PLNM using urine samples collected from a multi-center retrospective cohort (n = 413) as training set and validated in an independent multi-center prospective cohort (n = 243). Univariate and multivariate discriminant analyses were performed to measure the ability of the algorithm classifier to detect PLNM and compare it with the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram score. Results: An algorithm named 25 G PLNM-Score was developed and found to accurately distinguish PLNM and non-PLNM with AUC of 0.93 (95% CI: 0.85-1.01) and 0.93 (95% CI: 0.87-0.99) in the retrospective and prospective urine cohorts respectively. Kaplan-Meier plots showed large and significant difference in biochemical recurrence-free survival and distant metastasis-free survival in the patients stratified by the 25 G PLNM-Score (log rank P < 0.001 and P < 0.0001, respectively). It spared 96% and 80% of unnecessary PLND with only 0.51% and 1% of PLNM missing in the retrospective and prospective cohorts respectively. In contrast, the MSKCC score only spared 15% of PLND with 0% of PLNM missing. Conclusions: The novel 25 G PLNM-Score is the first highly accurate and non-invasive machine learning algorithm-based urine test to identify PLNM before PLND, with potential clinical benefits of avoiding unnecessary PLND and improving treatment decision-making.
Place, publisher, year, edition, pages
Nature Publishing Group, 2024.
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:mau:diva-66111DOI: 10.1038/s41391-023-00758-zISI: 001156530700001PubMedID: 38308042Scopus ID: 2-s2.0-85184212873OAI: oai:DiVA.org:mau-66111DiVA, id: diva2:1840789
2024-02-262024-02-262024-03-08Bibliographically approved