Diagnostic Accuracy of Contemporary Selection Criteria in Prostate Cancer Patients Eligible for Active Surveillance: A Bayesian Network Meta-Analysis

Frontiers in Oncology

Oncology

Juefei Feng¹  Yu Wang²  Wei Yu²  Yuke Chen²  Yelin Mulati²  Yu Fan³  Qian Zhang⁴  Lingyun Zhai⁵ 

[1] Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore;Department of Urology, Peking University First Hospital, Beijing, China;Institute of Urology, Peking University, Beijing, China;National Urological Cancer Center, Beijing, China;Department of Urology, Peking University First Hospital, Beijing, China;Institute of Urology, Peking University, Beijing, China;National Urological Cancer Center, Beijing, China;Department of Urology, Tibet Autonomous Region People’s Hospital, Lhasa, China;Department of Urology, Peking University First Hospital, Beijing, China;Institute of Urology, Peking University, Beijing, China;National Urological Cancer Center, Beijing, China;Peking University Binhai Hospital, Tianjin, China;Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China;

关键词: prostate cancer;    active surveillance;    selection criteria;    diagnostic accuracy;    Epstein criteria;    network meta-analysis;   

DOI  :  10.3389/fonc.2021.810736

 received in 2021-11-07, accepted in 2021-12-10,  发布年份 2022

来源: Frontiers

【 摘 要 】

BackgroundSeveral active surveillance (AS) criteria have been established to screen insignificant prostate cancer (insigPCa, defined as organ confined, low grade and small volume tumors confirmed by postoperative pathology). However, their comparative diagnostic performance varies. The aim of this study was to compare the diagnostic accuracy of contemporary AS criteria and validate the absolute diagnostic odds ratio (DOR) of optimal AS criteria.MethodsFirst, we searched Pubmed and performed a Bayesian network meta-analysis (NMA) to compare the diagnostic accuracy of contemporary AS criteria and obtained a relative ranking. Then, we searched Pubmed again to perform another meta-analysis to validate the absolute DOR of the top-ranked AS criteria derived from the NMA with two endpoints: insigPCa and favorable disease (defined as organ confined, low grade tumors). Subgroup and meta-regression analyses were conducted to identify any potential heterogeneity in the results. Publication bias was evaluated.ResultsSeven eligible retrospective studies with 3,336 participants were identified for the NMA. The diagnostic accuracy of AS criteria ranked from best to worst, was as follows: Epstein Criteria (EC), Yonsei criteria, Prostate Cancer Research International: Active Surveillance (PRIAS), University of Miami (UM), University of California-San Francisco (UCSF), Memorial Sloan-Kettering Cancer Center (MSKCC), and University of Toronto (UT). I2 = 50.5%, and sensitivity analysis with different insigPCa definitions supported the robustness of the results. In the subsequent meta-analysis of DOR of EC, insigPCa and favorable disease were identified as endpoints in ten and twenty-two studies, respectively. The pooled DOR for insigPCa and favorable disease were 0.44 (95%CI, 0.31–0.58) and 0.66 (95%CI, 0.61–0.71), respectively. According to a subgroup analysis, the DOR for favorable disease was significantly higher in US institutions than that in other regions. No significant heterogeneity or evidence of publication bias was identified.ConclusionsAmong the seven AS criteria evaluated in this study, EC was optimal for positively identifying insigPCa patients. The pooled diagnostic accuracy of EC was 0.44 for insigPCa and 0.66 when a more liberal endpoint, favorable disease, was used.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], PROSPERO [CRD42020157048].

【 授权许可】

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Copyright © 2022 Fan, Mulati, Zhai, Chen, Wang, Feng, Yu and Zhang