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Robust Meta-Analysis of a Clinical Cell-Cycle Risk (CCR) Score Demonstrates Broadly Applicable Metastasis and Disease-Specific Mortality Risk Stratification in Men With Localized Prostate Cancer.

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Personalizing Localized Prostate Cancer: Validation of a Combined Clinical Cell-cycle Risk (CCR) Score Threshold for

Jonathan D Tward1, Thorsten Schlomm2, Stephen Bardot3

  • 1Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.

Clinical Genitourinary Cancer
|February 20, 2021
PubMed
Summary
This summary is machine-generated.

The combined clinical cell-cycle risk (CCR) score helps identify prostate cancer patients who can safely avoid aggressive treatment. This validated score aids in deciding between single-modality or multimodality therapy for better patient outcomes.

Keywords:
ADT with radiationDisease progressionGenomic classifierMetastasisMultimodality therapy

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Area of Science:

  • Oncology
  • Urology
  • Medical Statistics

Background:

  • The combined clinical cell-cycle risk (CCR) score integrates cell-cycle progression (CCP) and CAPRA scores to predict disease progression in prostate cancer.
  • Validating the CCR score's prognostic ability is crucial for guiding treatment decisions in localized prostate cancer.

Purpose of the Study:

  • To further validate the prognostic accuracy of the CCR score in predicting metastasis.
  • To assess the CCR score's utility in determining eligibility for avoiding multimodality therapy in intermediate- and high-risk prostate cancer patients.

Main Methods:

  • A retrospective analysis of 718 men with National Comprehensive Cancer Network intermediate- or high-risk localized prostate cancer treated with single or multimodality therapy.
  • Evaluation of the CCR score and a CCR-based multimodality threshold (2.112) for predicting metastasis and treatment outcomes.

Main Results:

  • The CCR score significantly prognosticated metastasis in patients receiving single-modality therapy (HR 3.97 continuous, HR 15.90 dichotomized).
  • Ten-year metastasis risk was 4.3% for single-modality therapy patients with CCR scores below the threshold versus 20.4% for those above.
  • The CCR threshold identified 27% of high-risk and 73% of unfavorable intermediate-risk patients as potential candidates to avoid multimodality therapy.

Conclusions:

  • Patients with CCR scores below the multimodality threshold may safely forgo multimodality therapy.
  • The CCR score serves as a valuable decision aid for counseling patients on the sufficiency of single-modality therapy for their prostate cancer.