4Kscore diagnostic value in patients with high-grade prostate cancer using cutoff values of 7.5% to 10%: A meta-analysis

• Published in: Urologic oncology Vol. 39; no. 6; pp. 366.e1 - 366.e10
• Main Authors: Mi, Chao, Bai, Lu, Yang, Yuyang, Duan, Jie, Gao, Li
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2021
• Subjects: 4Kscore; Diagnosis; Meta-analysis; Prostate cancer; 4Kscore; Diagnosis; Prostate cancer; Meta-analysis
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2020.11.001

•Patients with 4Kscore results <7.5% have been proven to be at low risk of carrying high-grade prostate cancer.•We detected significant heterogeneity among the included studies, and no single study or study characteristic could account for the majority of this heterogeneity.•4Kscore can be used with cutoff values of 7.5% to 10% to detect high-grade prostate cancer. Reported 4Kscore thresholds used to differentiate between patients with and without high-grade prostate cancer (CaP) were variable. Patients with 4Kscore results <7.5% have been proven to be at low risk of carrying high-grade CaP. This study employed a meta-analysis approach in order to assess the diagnostic accuracy of the 4Kscore as a means of detecting high-grade CaP in prostate biopsy samples using cutoff values of 7.5% to 10%. Relevant studies published as of December 2019 were identified via searching PubMed, Embase, and Cochrane Library. Data pertaining to 4Kscore diagnostic accuracy were then extracted from these studies and utilized for the calculation of pooled sensitivity , specificity , diagnostic odds ratio , and area under the curve values relating to high-grade CaP diagnosis. In total, 9 studies incorporating 1,689 high-grade CaP patients were included in our meta-analysis. Following the exclusion of 1 outlier study, the pooled sensitivity, specificity , diagnostic odds ratio , and area under the curve values for 4Kscore diagnostic accuracy with corresponding 95% confidence intervals (CIs) were 0.90 (95%CI: 0.86–0.92), 0.44 (95%CI: 0.36–0.52), 7 (95%CI: 5–8), and 0.81 (95%CI: 0.77–0.84), respectively. These findings indicate that 4Kscore can be used as a model for the diagnosis of high-grade CaP. However, we detected significant heterogeneity among studies that was not explained by subgroup or meta-regression analysis, thus lowering our confidence in these results. It is therefore essential that future large, well-designed studies be conducted so as to confirm whether the 4Kscore can be used with cutoff values of 7.5% to 10% to reliably detect high-grade CaP.