Validity of the CAPRA score to predict biochemical recurrence-free survival after radical prostatectomy. Results from a European Multicenter survey of 1,296 patients
Validity of the CAPRA score to predict biochemical recurrence-free survival after radical prostatectomy. Results from a European Multicenter survey of 1,296 patients
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DOI：
10.1016/j.juro.2007.07.043
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发表时间：
2007-11-01
影响因子：
6.6
通讯作者：
Gralla, Oliver
中科院分区：
文献类型：
--
作者：
May, Matthias;Knoll, Nina;Gralla, Oliver
目的：美国加州大学旧金山分校的CAPRA （Cancer of The Prostate Risk Assessment，前列腺癌风险评估）评分为预测根治性前列腺切除术后无复发生存和病理肿瘤分期提供了一种新的统计模型。它最初是使用CaPSURE（前列腺癌战略泌尿研究努力）登记处的数据开发的。评分范围为0 ~ 10，需要5个临床变量，即前列腺特异性抗原、Gleason sum、临床肿瘤分级、活检阳性百分比和患者年龄。迄今为止，CAPRA评分的唯一外部验证是使用SEARCH（共享平等获取区域癌症医院）数据库进行的。本研究使用德国数据库来促进现有的验证工作，并测试CAPRA评分在临床特征方面与SEARCH样本根本不同的样本中的可转移性。材料和方法：来自1296名根治性前列腺切除术后的德国患者的数据用于验证。平均随访56.5个月（±35.4个月）。采用Kaplan-Meier分析、比例风险回归、logistic回归和图形表示分析CAPRA评分预测无复发生存期和病理肿瘤分期的准确性。结果：对于CAPRA评分的外部验证，与来自CaPSURE数据集的原始队列相比，我们研究组的潜在临床变量不利。CAPRA评分0 ~ 1分组3年和5年后无复发生存率分别从100%下降到97%，CAPRA评分7分及以上组分别从44%下降到31%。CAPRA总评分每增加1组生化复发的风险比为1.50 (95% CI 1.43-1.56)， 7组CAPRA评分为1.62 (95% CI 1.53-1.71)， 3组CAPRA评分为3.52 （95% CI 3.00-4.12）。一致性指数在0.78 ~ 0.81之间，预测准确率较高。在5个CAPRA成分中，有4个独立预测无复发生存，即前列腺特异性抗原、Gleason sum、cT分期和活检阳性百分比。CAPRA评分为0至1分的患者中有13.1%出现了阳性切缘，而评分为7至10分的患者中有62%出现了阳性切缘（p < 0.001）。CAPRA评分为0 ~ 1分的患者中有97.7%存在器官局限性肿瘤，而评分为7 ~ 10分的患者中有19.3%存在器官局限性肿瘤（p < 0.001）。结论：尽管当前患者队列和CaPSURE数据集的临床特征不同，但CAPRA nomogram预测无复发生存期的准确性很高。这些结果强调了CAPRA评分的有效性和临床适用性，除了患者咨询外，还可用于临床研究中的风险分层。
Purpose: The CAPRA (Cancer of the Prostate Risk Assessment) score from the University of California, San Francisco provides a new statistical model to predict recurrence-free survival and pathological tumor stage after radical prostatectomy. It was originally developed using data from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) registry. To calculate the score, which ranges from 0 to 10, 5 clinical variables are needed, ie prostate specific antigen, Gleason sum, clinical tumor grade, percentage of positive biopsies and patient age. To date, the only external validation of the CAPRA score has been conducted using the SEARCH (Shared Equal Access Regional Cancer Hospital) database. The present study uses a German database to contribute to existing validation work and to test transferability of the CAPRA score to a sample that differs fundamentally from the SEARCH sample in terms of clinical features.Materials and Methods: Data from 1,296 German patients after radical prostatectomy were used for validation. Mean followup was 56.5 (+/- 35.4) months. Accuracy of prediction of recurrence-free survival and pathological tumor stage with the CAPRA score was analyzed using Kaplan-Meier analysis, proportional hazards regression, logistic regression and graphic representation.Results: For the external validation of the CAPRA score, the underlying clinical variables of our study group were unfavorable compared to the original cohort from the CaPSURE data set. The recurrence-free survival rate decreased after 3 and 5 years from 100% to 97%, respectively, in the CAPRA score 0 to 1 group, and from 44% to 31%, respectively, in the CAPRA score of 7 or higher group. The hazard ratios of a biochemical recurrence per 1-group increase were 1.50 (95% CI 1.43-1.56) for the CAPRA sum score, 1.62 (95% CI 1.53-1.71) for the 7-group CAPRA score and 3.52 (95% CI 3.00-4.12) for the 3-group CAPRA score. Concordance indices between 0.78 and 0.81 suggested good predictive accuracy. Of the 5 CAPRA constituents 4 independently predicted recurrence-free survival, ie prostate specific antigen, Gleason sum, cT stage and percent of positive biopsies. Positive margins occurred in 13.1% of patients with a CAPRA score of 0 to 1 vs 62% of patients with a score of 7 to 10 (p < 0.001). Organ confined tumors were present in 97.7% of patients with a CAPRA score of 0 to 1 vs 19.3% of those with a score of 7 to 10 (p < 0.001).Conclusions: Despite different clinical features in the present patient cohort and the CaPSURE data set, the accuracy of the CAPRA nomogram in predicting recurrence-free survival was high. These results underscore the effectiveness and the clinical applicability of the CAPRA score which, in addition to patient counseling, may also be used for risk stratification in clinical studies.