A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer
A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer
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DOI：
10.1097/01.ju.0000091805.98960.13
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发表时间：
2003-11-01
影响因子：
6.6
通讯作者：
Kattan, MW
中科院分区：
文献类型：
--
作者：
Cagiannos, I;Karakiewicz, P;Kattan, MW
目的：我们开发了一个术前nomogram预测淋巴结转移的患者与临床定位prostate cancer.Materials和方法：这项研究是一个回顾性的，非随机分析的7,014例患者在1985年和2000年之间的6个机构进行根治性前列腺切除术。排除标准包括术前雄激素消融治疗、补救性根治性前列腺切除术和治疗前前列腺特异性抗原（PSA）大于50 ng/ml。术前预测淋巴结转移的因素包括术前PSA、临床分期（1992年TNM）和活检Gleason总和。这些预测因素被用于逻辑回归分析的诺模图预测淋巴结转移的概率。结果：共有5,510例患者的完整的临床和病理信息被纳入研究。淋巴结转移206例（3.7%）。治疗前PSA、活检Gleason总和、临床分期和机构是淋巴结状态的预测因素（p < 0.001）。3变量列线图（临床分期、Gleason总和和PSA）的Bootstrap校正预测准确度为0.76。纳入第四个变量，这是淋巴结转移的机构差异，产生了0.78的受试者工作特征曲线下面积。我们的列线图的阴性预测值为0.99时，他们预测3%或更少的机会阳性lymph nodes.Conclusions：使用临床信息，我们产生了2校准和验证列线图，准确预测病理阴性淋巴结的男性与局限性前列腺癌谁是根治性前列腺切除术的候选人。
Purpose: We developed a preoperative nomogram for prediction of lymph node metastases in patients with clinically localized prostate cancer.Materials and Methods: The study was a retrospective, nonrandomized analysis of 7,014 patients treated with radical prostatectomy at 6 institutions between 1985 and 2000. Exclusion criteria consisted of preoperative androgen ablation therapy, salvage radical prostatectomy and pretreatment prostate specific antigen (PSA) greater than 50 ng/ml. Preoperative predictors of lymph node metastases consisted of pretreatment PSA, clinical stage (1992 TNM) and biopsy Gleason sum. These predictors were used in logistic regression analysis based nomograms to predict the probability of lymph node metastases.Results: Overall 5,510 patients with complete clinical and pathological information were included in the study. Lymph nodes metastases were present in 206 patients (3.7%). Pretreatment PSA, biopsy Gleason sum, clinical stage and institution represented predictors of lymph node status (p < 0.001). Bootstrap corrected predictive accuracy of the 3-variable nomogram (clinical stage, Gleason sum and PSA) was 0.76. Inclusion of a fourth variable, which accounts for institutional differences in lymph node metastases, yielded an area under the receiver operating characteristics curve of 0.78. The negative predictive value of our nomograms was 0.99 when they predicted 3% or less chance of positive lymph nodes.Conclusions: Using clinical information, we produced 2 calibrated and validated nomograms, which accurately predict pathologically negative lymph nodes in men with localized prostate cancer who are candidates for radical prostatectomy.