A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer
A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer
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DOI：
10.1093/jnci/90.10.766
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发表时间：
1998-05-20
影响因子：
10.3
通讯作者：
Scardino, PT
中科院分区：
文献类型：
--
作者：
Kattan, MW;Eastham, JA;Scardino, PT
背景：很少有已发表的研究将临床预后因素与风险概况结合起来，可用于预测前列腺癌治疗后患者复发或转移进展的可能性。我们开发了一个列线图，可以通过使用术前临床因素来预测适合接受根治性前列腺切除术治疗的临床局限性前列腺癌患者的疾病复发，方法：通过使用 Cox 比例风险回归分析，我们对 983 名患有临床局限性前列腺癌且打算接受根治性前列腺切除术治疗的男性的临床数据和疾病随访进行了建模，临床数据包括预处理 血清前列腺特异性抗原水平、活检格里森评分和临床分期。当有疾病复发的临床证据、血清前列腺特异性抗原水平上升（两次测量结果为 0.4 ng/mL 或更高且不断上升）或开始辅助治疗时，记录治疗失败。对同样来自我们机构的 168 名男性的单独样本进行验证。结果：983 名男性中有 196 名出现治疗失败（即癌症复发），没有失败的患者中位随访时间为 30 个月（范围为 1-146 个月），该队列的 5 年无失败概率为 73%（95% 置信区间 = 69%-76%）。列线图的预测显得准确且具有辨别力，受试者工作特征曲线下的验证样本面积（即预测概率与实际结果的比较）为 0.79。 结论：已经开发出列线图，可用于预测接受根治性前列腺切除术治疗的临床局限性前列腺癌男性 5 年治疗失败的概率。
Background: Few published studies have combined clinical prognostic factors into risk profiles that can be used to predict the likelihood of recurrence or metastatic progression in patients following treatment of prostate cancer. We developed a nomogram that allows prediction of disease recurrence through use of preoperative clinical factors for patients with clinically localized prostate cancer who are candidates for treatment with a radical prostatectomy, Methods: By use of Cox proportional hazards regression analysis, we modeled the clinical data and disease follow-up for 983 men with clinically localized prostate cancer whom we intended to treat with a radical prostatectomy, Clinical data included pretreatment serum prostate-specific antigen levels, biopsy Gleason scores, and clinical stage. Treatment failure was recorded when there was clinical evidence of disease recurrence, a rising serum prostate-specific antigen level (two measurements of 0.4 ng/mL or greater and rising), or initiation of adjuvant therapy, Validation was performed on a separate sample of 168 men, also from our institution. Results: Treatment failure (i.e., cancer recurrence) was noted in 196 of the 983 men, and the patients without failure had a median follow-up of 30 months (range, 1-146 months), The 5-year probability of freedom from failure for the cohort was 73% (95% confidence interval = 69%-76%). The predictions from the nomogram appeared accurate and discriminating, with a validation sample area under the receiver operating characteristic curve (i.e., comparison of the predicted probability with the actual outcome) of 0.79, Conclusions: A nomogram has been developed that can be used to predict the 5-year probability of treatment failure among men with clinically localized prostate cancer treated with radical prostatectomy.