Contemporary identification of patients at high risk of early prostate cancer recurrence after radical retropubic prostatectomy
Contemporary identification of patients at high risk of early prostate cancer recurrence after radical retropubic prostatectomy
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DOI：
10.1016/s0090-4295(01)00978-5
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发表时间：
2001-06-01
期刊：
影响因子：
2.1
通讯作者：
Partin, AW
中科院分区：
文献类型：
--
作者：
Roberts, WW;Bergstralh, EJ;Partin, AW
目的，开发一个模型，用于识别临床局部疾病根治性耻骨后前列腺切除术后早期前列腺癌复发高风险（36 个月时大于 50%）的当代患者队列，该模型的数据将为患者选择和辅助治疗前瞻性随机试验的设计提供重要信息。方法。将比例风险回归分析应用于两个患者队列，以开发和交叉验证多因素预测模型，以确定早期前列腺癌复发风险最高的男性。模型队列和验证队列分别包含 904 名和 901 名男性，他们在约翰·霍普金斯医院接受了根治性耻骨后前列腺切除术。然后使用梅奥诊所的一组患者对该模型进行了外部验证。结果。建立了复发风险加权模型：R-w' = 淋巴结受累 (0/1) x 1.43 + 手术切缘状态 (0/1) x 1.15 + 改良格里森评分 (0 至 4) x 0.71 + 精囊受累 (0/1) x 0.51。 R-w' 大于 2.84 (9%) 的男性在 3 年内表现出 50% 的生化复发率（前列腺特异性抗原水平大于 0.2 ng/mL），因此被归入高风险组。生化无复发生存率的 Kaplan-Meier 分析表明，基于 R-w' 的曲线出现快速偏差。该模型在第二组患者中进行了交叉验证，并得到了相似的结果。此外，当该模型在 Mayo Clinic 治疗的患者上进行外部验证时，类似的趋势也很明显。结论，我们开发了一种多变量 Cox 比例风险模型，该模型根据早期前列腺癌复发的风险成功对患者进行了分层。泌尿学 57: 1033-1037, 2001。(C) 2001，爱思唯尔科学公司。
Objectives, To develop a model that will identify a contemporary cohort of patients at high risk of early prostate cancer recurrence (greater than 50% at 36 months) after radical retropubic prostatectomy for clinically localized disease, Data from this model will provide important information for patient selection and the design of prospective randomized trials of adjuvant therapies.Methods. Proportional hazards regression analysis was applied to two patient cohorts to develop and cross-validate a multifactorial predictive model to identify men with the highest risk of early prostate cancer recurrence. The model and validation cohorts contained 904 and 901 men, respectively, who underwent radical retropubic prostatectomy at Johns Hopkins Hospital. This model was then externally validated using a cohort of patients from the Mayo Clinic.Results. A model for weighted risk of recurrence was developed: R-w' = lymph node involvement (0/1) x 1.43 + surgical margin status (0/1) x 1.15 + modified Gleason score (0 to 4) x 0.71 + seminal vesicle involvement (0/1) x 0.51. Men with an R-w' greater than 2.84 (9%) demonstrated a 50% biochemical recurrence rate (prostrate-specific antigen level greater than 0.2 ng/mL) at 3 years and thus were placed in the high-risk group. Kaplan-Meier analyses of biochemical recurrence-free survival demonstrated rapid deviation of the curves based on the R-w'. This model was cross-validated in the second group of patients and performed with similar results. Furthermore, similar trends were apparent when the model was externally validated on patients treated at the Mayo Clinic.Conclusions, We have developed a multivariate Cox proportional hazards model that successfully stratifies patients on the basis of their risk of early prostate cancer recurrence. UROLOGY 57: 1033-1037, 2001. (C) 2001, Elsevier Science Inc.