|
1
|
Johnson H, Guo J, Zhang X, Zhang H, Simoulis A, Wu AHB, Xia T, Li F, Tan W, Johnson A, Dizeyi N, Abrahamsson PA, Kenner L, Feng X, Zou C, Xiao K, Persson JL, Chen L. Development and validation of a 25-Gene Panel urine test for prostate cancer diagnosis and potential treatment follow-up. BMC Med 2020; 18:376. [PMID: 33256740 PMCID: PMC7706045 DOI: 10.1186/s12916-020-01834-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heterogeneity of prostate cancer (PCa) contributes to inaccurate cancer screening and diagnosis, unnecessary biopsies, and overtreatment. We intended to develop non-invasive urine tests for accurate PCa diagnosis to avoid unnecessary biopsies. METHODS Using a machine learning program, we identified a 25-Gene Panel classifier for distinguishing PCa and benign prostate. A non-invasive test using pre-biopsy urine samples collected without digital rectal examination (DRE) was used to measure gene expression of the panel using cDNA preamplification followed by real-time qRT-PCR. The 25-Gene Panel urine test was validated in independent multi-center retrospective and prospective studies. The diagnostic performance of the test was assessed against the pathological diagnosis from biopsy by discriminant analysis. Uni- and multivariate logistic regression analysis was performed to assess its diagnostic improvement over PSA and risk factors. In addition, the 25-Gene Panel urine test was used to identify clinically significant PCa. Furthermore, the 25-Gene Panel urine test was assessed in a subset of patients to examine if cancer was detected after prostatectomy. RESULTS The 25-Gene Panel urine test accurately detected cancer and benign prostate with AUC of 0.946 (95% CI 0.963-0.929) in the retrospective cohort (n = 614), AUC of 0.901 (0.929-0.873) in the prospective cohort (n = 396), and AUC of 0.936 (0.956-0.916) in the large combination cohort (n = 1010). It greatly improved diagnostic accuracy over PSA and risk factors (p < 0.0001). When it was combined with PSA, the AUC increased to 0.961 (0.980-0.942). Importantly, the 25-Gene Panel urine test was able to accurately identify clinically significant and insignificant PCa with AUC of 0.928 (95% CI 0.947-0.909) in the combination cohort (n = 727). In addition, it was able to show the absence of cancer after prostatectomy with high accuracy. CONCLUSIONS The 25-Gene Panel urine test is the first highly accurate and non-invasive liquid biopsy method without DRE for PCa diagnosis. In clinical practice, it may be used for identifying patients in need of biopsy for cancer diagnosis and patients with clinically significant cancer for immediate treatment, and potentially assisting cancer treatment follow-up.
Collapse
Affiliation(s)
| | - Jinan Guo
- Department of Urology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen Urology Minimally Invasive Engineering Centre, Shenzhen, China.,Shenzhen Public Service Platform on Tumor Precision Medicine and Molecular Diagnosis, Clinical Medical Research Centre, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Xuhui Zhang
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, Beijing, China
| | - Heqiu Zhang
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, Beijing, China
| | - Athanasios Simoulis
- Department of Clinical Pathology and Cytology, Skåne University Hospital, Malmö, Sweden
| | - Alan H B Wu
- Clinical Laboratories, San Francisco General Hospital, San Francisco, CA, USA
| | - Taolin Xia
- Department of Urology, Foshan First People's Hospital, Foshan, China
| | - Fei Li
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wanlong Tan
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | | | - Nishtman Dizeyi
- Department of Translational Medicine, Lund University, Clinical Research Centre, Malmö, Sweden
| | - Per-Anders Abrahamsson
- Department of Translational Medicine, Lund University, Clinical Research Centre, Malmö, Sweden
| | - Lukas Kenner
- Department of Experimental Pathology, Medical University Vienna & Unit of Laboratory Animal Pathology, University of Veterinary Medicine, Vienna, Austria
| | - Xiaoyan Feng
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, Beijing, China
| | - Chang Zou
- Shenzhen Public Service Platform on Tumor Precision Medicine and Molecular Diagnosis, Clinical Medical Research Centre, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Kefeng Xiao
- Department of Urology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen Urology Minimally Invasive Engineering Centre, Shenzhen, China.,Shenzhen Public Service Platform on Tumor Precision Medicine and Molecular Diagnosis, Clinical Medical Research Centre, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Jenny L Persson
- Department of Molecular Biology, Umeå University, 901 87, Umeå, Sweden. .,Division of Experimental Cancer Research, Department of Translational Medicine, Lund University, 205 02, Malmö, Sweden. .,Department of Biomedical Sciences, Malmö University, Malmö, Sweden.
| | - Lingwu Chen
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
| |
Collapse
|
|
2
|
Jayadevappa R, Chhatre S, Gallo JJ, Wittink MN, Morales KH, Lee DI, Guzzo T, Vapiwala N, Wong YN, Newman DK, Van Arsdalen K, Malkowicz SB, Schwartz JS, Wein AJ. Reply to A. Vickers et al. J Clin Oncol 2019; 37:3463-3464. [DOI: 10.1200/jco.19.01450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ravishankar Jayadevappa
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Sumedha Chhatre
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Joseph J. Gallo
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Marsha N. Wittink
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Knashawn H. Morales
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - David I. Lee
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Thomas Guzzo
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Neha Vapiwala
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Yu-Ning Wong
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Diane K. Newman
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Keith Van Arsdalen
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - S. Bruce Malkowicz
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - J. Sanford Schwartz
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Alan J. Wein
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| |
Collapse
|