Shariat Shahrokh F, Park Sangtae, Trinh Quoc-Dien, Roehrborn Claus G, Slawin Kevin M, Karakiewicz Pierre I
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
J Urol. 2007 Oct;178(4 Pt 1):1229-36; discussion 1236-7. doi: 10.1016/j.juro.2007.05.161. Epub 2007 Aug 14.
We tested whether the addition of preoperative circulating plasminogen activator inhibitor type I levels improves the accuracy of standard preoperative and postoperative models for prediction of biochemical recurrence after radical prostatectomy.
Preoperative plasma levels of plasminogen activator inhibitor type I were measured in 429 consecutive patients treated with radical prostatectomy for clinically localized prostate cancer. The patients were randomly divided into a development (67%, 286) and a split sample validation cohort (33%, 143). Cox regression analysis was used to develop prognostic nomograms for prediction of biochemical recurrence.
In standard univariate analyses categorically coded preoperative plasminogen activator inhibitor type I was significantly associated with biochemical recurrence (p <0.001). In standard preoperative and postoperative multivariate analyses preoperative plasminogen activator inhibitor type I was independently associated with biochemical recurrence (p <0.001 and p = 0.002, respectively). In the split sample validation cohort the addition of plasminogen activator inhibitor type I increased the predictive accuracy of the preoperative multivariate model by 1.2%, 7.7%, 10.3%, 6.7% and 5.4% at 1, 2, 3, 4 and 5 years, respectively (p values <0.001). Moreover, the addition of plasminogen activator inhibitor type I increased the predictive accuracy of the postoperative model by 0.5%, 1.1%, 4.0%, 2.4% and 3.6% at 1, 2, 3, 4 and 5 years, respectively (p values <0.001).
Preoperative circulating plasminogen activator inhibitor type I is a predictor of biochemical recurrence, and it enhances the accuracy of preoperative and postoperative nomograms. After external validation these nomograms may assist clinical decision making regarding treatment choice and followup as well as identification of patients at high risk for biochemical recurrence who may benefit from neoadjuvant and/or adjuvant treatment.
我们测试了术前循环纤溶酶原激活物抑制剂I型水平的加入是否能提高标准术前和术后模型预测根治性前列腺切除术后生化复发的准确性。
对429例因临床局限性前列腺癌接受根治性前列腺切除术的连续患者测量术前血浆纤溶酶原激活物抑制剂I型水平。患者被随机分为一个开发队列（67%，286例）和一个分割样本验证队列（33%，143例）。采用Cox回归分析来制定预测生化复发的预后列线图。
在标准单变量分析中，分类编码的术前纤溶酶原激活物抑制剂I型与生化复发显著相关（p<0.001）。在标准术前和术后多变量分析中，术前纤溶酶原激活物抑制剂I型分别与生化复发独立相关（分别为p<0.001和p = 0.002）。在分割样本验证队列中，加入纤溶酶原激活物抑制剂I型后，术前多变量模型在1、2、3、4和5年时的预测准确性分别提高了1.2%、7.7%、10.3%、6.7%和5.4%（p值<0.001）。此外，加入纤溶酶原激活物抑制剂I型后，术后模型在1、2、3、4和5年时的预测准确性分别提高了0.5%、1.1%、4.0%、2.4%和3.6%（p值<0.001）。
术前循环纤溶酶原激活物抑制剂I型是生化复发的一个预测指标，并且它提高了术前和术后列线图的准确性。经过外部验证后，这些列线图可能有助于临床决策，包括治疗选择和随访，以及识别可能从新辅助和/或辅助治疗中获益的生化复发高危患者。
