External validation of the Prostate Cancer Prevention Trial and the European Randomized Study of Screening for Prostate Cancer risk calculators in a Chinese cohort
External validation of the Prostate Cancer Prevention Trial and the European Randomized Study of Screening for Prostate Cancer risk calculators in a Chinese cohort
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DOI：
10.1038/aja.2012.28
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发表时间：
2012-09-01
影响因子：
2.9
通讯作者：
Ye, Ding-Wei
中科院分区：
文献类型：
--
作者：
Zhu, Yao;Wang, Jin-You;Ye, Ding-Wei
已经开发了几种预测模型来估计前列腺活检的结果。这些工具中的大多数是为西方人群设计的，尚未在不同种族群体中得到验证。因此，我们评估了前列腺癌预防试验（PCPT）和欧洲前列腺癌筛查随机研究（ERSPC）风险计算器在中国队列中的预测价值。从2009年1月至2011年3月期间接受扩展前列腺活检的495名中国男性中获得临床病理信息。使用PCPT和ERSPC风险计算器计算前列腺癌和高级别疾病（Gleason > 6）的估计概率。对模型评价的总体测量、区分度、校准和临床有用性进行了评估。在这些患者中，28.7%被诊断患有前列腺癌，19.4%患有高级别疾病。与PCPT模型和4 ng ml（-1）的前列腺特异性抗原（PSA）阈值相比，ERSPC风险计算器在预测阳性活检和高级别疾病方面表现出更好的区分能力（曲线下面积分别为0.831和0.852，P均< 0.01）。决策曲线分析还表明，ERSPC计算器在验证数据集中具有良好的临床实用性。两种预测模型均显示出错误校准：前列腺癌和高级别疾病的风险在很大范围的预测概率中被高估了约20%。总之，ERSPC风险计算器在预测中国患者前列腺癌和高级别疾病方面优于PCPT模型和PSA阈值4 ng ml（-1）。然而，与中国队列的活检结果相比，来自西方男性的预测工具显著高估了前列腺癌和高级别疾病的概率。Asian Journal of Andrology（2012）14，738-744; doi：10.1038/aja.2012.28; 2012年5月7日在线发表
Several prediction models have been developed to estimate the outcomes of prostate biopsies. Most of these tools were designed for use with Western populations and have not been validated across different ethnic groups. Therefore, we evaluated the predictive value of the Prostate Cancer Prevention Trial (PCPT) and the European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculators in a Chinese cohort. Clinicopathological information was obtained from 495 Chinese men who had undergone extended prostate biopsies between January 2009 and March 2011. The estimated probabilities of prostate cancer and high-grade disease (Gleason > 6) were calculated using the PCPT and ERSPC risk calculators. Overall measures, discrimination, calibration and clinical usefulness were assessed for the model evaluation. Of these patients, 28.7% were diagnosed with prostate cancer and 19.4% had high-grade disease. Compared to the PCPT model and the prostate-specific antigen (PSA) threshold of 4 ng ml(-1), the ERSPC risk calculator exhibited better discriminative ability for predicting positive biopsies and high-grade disease (the area under the curve was 0.831 and 0.852, respectively, P < 0.01 for both). Decision curve analysis also suggested the favourable clinical utility of the ERSPC calculator in the validation dataset. Both prediction models demonstrated miscalibration: the risk of prostate cancer and high-grade disease was overestimated by approximately 20% for a wide range of predicted probabilities. In conclusion, the ERSPC risk calculator outperformed both the PCPT model and the PSA threshold of 4 ng ml(-1) in predicting prostate cancer and high-grade disease in Chinese patients. However, the prediction tools derived from Western men significantly overestimated the probability of prostate cancer and high-grade disease compared to the outcomes of biopsies in a Chinese cohort. Asian Journal of Andrology (2012) 14, 738-744; doi:10.1038/aja.2012.28; published online 7 May 2012