Postoperative nomogram for disease recurrence after radical prostatectomy for prostate cancer
Postoperative nomogram for disease recurrence after radical prostatectomy for prostate cancer
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DOI：
10.1200/jco.1999.17.5.1499
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发表时间：
1999-05-01
影响因子：
45.3
通讯作者：
Scardino, PT
中科院分区：
文献类型：
--
作者：
Kattan, MW;Wheeler, TM;Scardino, PT
目的：虽然存在模型，将患者分为不同风险的疾病复发后，前列腺癌手术的离散组，我们知道没有出版的工作，结合病理因素来预测个人的疾病复发的概率。由于临床分期和活检Gleason分级仅近似于乳腺癌切除标本的病理分期和Gleason分级，因此将术后信息加入术前变量后，预后预测应更准确。因此，我们开发了一种术后列线图，与我们以前发表的术前列线图相比，它可以更准确地预测接受根治性前列腺切除术治疗前列腺癌患者的疾病复发概率。通过考克斯比例风险回归分析，我们模拟了996名临床分期为T1 a-T3 c NXM 0前列腺癌的男性患者的临床和病理数据以及疾病随访，这些患者在我们的机构由一名外科医生进行根治性前列腺切除术。预后变量包括治疗前血清前列腺特异性抗原水平、标本Gleason总和、前列腺包膜浸润、手术切缘状态、精囊浸润和淋巴结状态。当有疾病复发的临床证据、血清前列腺特异性抗原水平升高（两次测量值≥ 0.4 ng/mL且升高）或开始辅助治疗时，记录治疗失败。验证进行了这一组的男子和一个单独的样本322名男子从其他五个外科医生的做法从我们institution.Results：癌症复发的996名男子中的189人，和复发组有一个中位数为37个月（范围，1至168个月）的随访期。该队列的7年无复发概率为73%（95%置信区间，68%至76%）。诺模图的预测结果是准确的，受试者工作特征曲线下的有效样本面积（即预测概率与实际结果的比较）为0.89。结论：已建立的诺模图可用于预测根治性乳腺癌切除术后7年的复发概率。J Clin Oncol 17：1499-1507. (C)1999年，美国临床肿瘤学会。
Purpose: Although models exist that place patients into discrete groups at various risks for disease recurrence after surgery for prostate cancer, we know of no published work that combines pathologic factors to predict an individual's probability of disease recurrence. Because clinical stage and biopsy Gleason grade only approximate pathologic stage and Gleason grade in the prostatectomy specimen, prediction of prognosis should be more accurate when postoperative information is added to preoperative variables. Therefore, we developed a postoperative nomogram that allows more accurate prediction of probability for disease recurrence for patients who have received radical prostatectomy as treatment for prostate cancer, compared with the preoperative nomogram we previously published.Patients and Methods: By Cox proportional hazards regression analysis, we modeled the clinical and pathologic data and disease follow-up for 996 men with clinical stage T1a-T3c NXM0 prostate cancer who were treated with radical prostatectomy by a single surgeon at our institution. Prognostic variables included pretreatment serum prostate-specific antigen level, specimen Gleason sum, prostatic capsular invasion, surgical margin status, seminal vesicle invasion, and lymph node status. Treatment failure was recorded when there was either 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 this set of men and a separate sample of 322 men from five other surgeons' practices from our institution.Results: Cancer recurrence was noted in 189 of the 996 men, and the recurrence-free group had a median follow-up period of 37 months (range, 1 to 168 months). The 7-year recurrence-free probability for the cohort was 73% (95% confidence interval, 68% to 76%). The predictions from the nomogram appeared to be accurate and discriminating, with a validation sample area under the receiver operating characteristic curve (ie, a comparison of the predicted probability with the actual outcome) of 0.89.Conclusion: A postoperative nomogram has been developed that can be used to predict the 7-year probability of disease recurrence among men treated with radical prostatectomy. J Clin Oncol 17:1499-1507. (C) 1999 by American Society of Clinical Oncology.