Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology
Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology
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DOI：
10.1016/j.eururo.2005.11.007
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发表时间：
2006-05-01
期刊：
影响因子：
23.4
通讯作者：
Karakiewicz, PI
中科院分区：
文献类型：
--
作者：
Chun, FKH;Steuber, T;Karakiewicz, PI
目的：先前的报告表明，多达43%的活检时患有低级别PCa的男性在RP时将被诊断为高级别PCa。我们探索了当代队列中从活检升级到RP标本的速度，并开发了一个能够预测活检格里森总和升级概率的模型。材料和方法：该研究队列由2982名接受RP治疗的男性组成，具有可用的临床分期、血清前列腺特异性抗原和活检格里森评分。这些临床数据被用作多变量逻辑回归模型（LRM）中的预测因子，该模型解决了活检和RP病理学之间的格里森总和升级率。LRM回归系数被用来开发一个诺模图预测格里森和升级的概率，并进行了200自助重新采样的内部验证，以减少过拟合bias.Results：总体而言，875例患者升级（29.3%）。在多变量LRM中，所有预测因子均高度显著（所有p值< 0.0001）。预测活检和RP之间Gleason和升级概率的诺模图的Bootstrap校正预测准确度为0.804。结论：我们开发了一种高度准确的临床治疗决策辅助工具。当一个更积极的格里森变异体的可能性可能改变治疗选择时，它可能被证明是有用的。(c)2005 Elsevier B.V.保留所有权利。
Objective: Previous reports indicate that as many as 43% of men with low grade PCa at biopsy will be diagnosed with high-grade PCa at RP. We explored the rate of upgrading from biopsy to RP specimen in our contemporary cohort, and developed a model capable of predicting the probability of biopsy Gleason sum upgrading.Materials and Methods: The study cohort consisted of 2982 men treated with RP, with available clinical stage, serum prostate specific antigen and biopsy Gleason scores. These clinical data were used as predictors in multivariate logistic regression models (LRM) addressing the rate of Gleason sum upgrading between biopsy and RP pathology. LRM regression coefficients were used to develop a nomogram predicting the probability of Gleason sum upgrading and was subjected to 200 bootstrap resamples for internal validation and to reduce overfit bias.Results: Overall, 875 patients were upgraded (29.3%). In multivariate LRMs, all predictors were highly significant (all p values < 0.0001). Bootstrap-corrected predictive accuracy of the nomogram predicting the probability of Gleason sum upgrading between biopsy and RP was 0.804.Conclusion: We developed a highly accurate clinical aid for treatment decision-making. it may prove useful when the possibility of a more aggressive Gleason variant may change the treatment options. (c) 2005 Elsevier B.V. All rights reserved.