Cooperberg Matthew R, Pasta David J, Elkin Eric P, Litwin Mark S, Latini David M, Du Chane Janeen, Carroll Peter R
University of California, San Francisco, San Francisco, USA.
J Urol. 2005 Jun;173(6):1938-42. doi: 10.1097/01.ju.0000158155.33890.e7.
Multivariate prognostic instruments aim to predict risk of recurrence among patients with localized prostate cancer. We devised a novel risk assessment tool which would be a strong predictor of outcome across various levels of risk, and which could be easily applied and intuitively understood.
We studied 1,439 men diagnosed between 1992 and 2001 who had undergone radical prostatectomy and were followed in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database, a longitudinal, community based disease registry of patients with prostate cancer. Disease recurrence was defined as prostate specific antigen (PSA) 0.2 ng/ml or greater on 2 consecutive occasions following prostatectomy or a second cancer treatment more than 6 months after surgery. The University of California, San Francisco-Cancer of the Prostate Risk Assessment (UCSF-CAPRA) score was developed using preoperative PSA, Gleason score, clinical T stage, biopsy results and age. The index was developed and validated using Cox proportional hazards and life table analyses.
A total of 210 patients (15%) had recurrence, 145 by PSA criteria and 65 by second treatment. Based on the results of the Cox analysis, points were assigned based on PSA (0 to 4 points), Gleason score (0 to 3), T stage (0 to 1), age (0 to 1) and percent of biopsy positive cores (0 to 1). The UCSF-CAPRA score range is 0 to 10, with roughly double the risk of recurrence for each 2-point increase in score. Recurrence-free survival at 5 years ranged from 85% for a UCSF-CAPRA score of 0 to 1 (95% CI 73%-92%) to 8% for a score of 7 to 10 (95% CI 0%-28%). The concordance index for the UCSF-CAPRA score was 0.66.
The UCSF-CAPRA score is a straightforward yet powerful preoperative risk assessment tool. It must be externally validated in future studies.
多变量预后工具旨在预测局限性前列腺癌患者的复发风险。我们设计了一种新型风险评估工具，它能有力地预测不同风险水平患者的预后，且易于应用和直观理解。
我们研究了1992年至2001年间诊断出的1439名男性，他们均接受了根治性前列腺切除术，并在前列腺癌战略泌尿学研究计划（CaPSURE）数据库中进行随访，该数据库是一个基于社区的前列腺癌患者纵向疾病登记处。疾病复发定义为前列腺切除术后连续两次前列腺特异性抗原（PSA）≥0.2 ng/ml，或术后6个月以上进行第二次癌症治疗。加利福尼亚大学旧金山分校前列腺癌风险评估（UCSF-CAPRA）评分通过术前PSA、Gleason评分、临床T分期、活检结果和年龄得出。该指数通过Cox比例风险模型和生命表分析得出并验证。
共有210名患者（15%）复发，145名符合PSA标准，65名通过二次治疗判定复发。基于Cox分析结果，根据PSA（0至4分）、Gleason评分（0至3分）、T分期（0至1分）、年龄（0至1分）和活检阳性核心百分比（0至1分）进行评分。UCSF-CAPRA评分范围为0至10分，评分每增加2分，复发风险大致翻倍。5年无复发生存率从UCSF-CAPRA评分为0至1分时的85%（95%CI 73%-92%）到评分为7至10分时的8%（95%CI 0%-28%）。UCSF-CAPRA评分的一致性指数为0.66。
UCSF-CAPRA评分是一种简单而有效的术前风险评估工具。未来研究中必须对其进行外部验证。
