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CAPRA评分预测根治性前列腺切除术后无生化复发生存率的有效性。来自欧洲1296例患者的多中心调查结果。

Validity of the CAPRA score to predict biochemical recurrence-free survival after radical prostatectomy. Results from a european multicenter survey of 1,296 patients.

作者信息

May Matthias, Knoll Nina, Siegsmund Michael, Fahlenkamp Dirk, Vogler Horst, Hoschke Bernd, Gralla Oliver

机构信息

Department of Urology, Carl-Thiem Hospital, Cottbus, Germany.

出版信息

J Urol. 2007 Nov;178(5):1957-62; discussion 1962. doi: 10.1016/j.juro.2007.07.043. Epub 2007 Sep 17.

Abstract

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.

摘要

目的

加利福尼亚大学旧金山分校的CAPRA(前列腺癌风险评估)评分提供了一种新的统计模型,用于预测根治性前列腺切除术后的无复发生存率和病理肿瘤分期。它最初是使用CaPSURE(前列腺癌战略泌尿外科研究计划)登记处的数据开发的。要计算范围为0至10的评分,需要5个临床变量,即前列腺特异性抗原、Gleason评分总和、临床肿瘤分级、阳性活检百分比和患者年龄。迄今为止,CAPRA评分的唯一外部验证是使用SEARCH(共享平等访问区域癌症医院)数据库进行的。本研究使用德国数据库为现有的验证工作做出贡献,并测试CAPRA评分在临床特征上与SEARCH样本有根本差异的样本中的可转移性。

材料与方法

使用1296例德国患者根治性前列腺切除术后的数据进行验证。平均随访时间为56.5(±35.4)个月。使用Kaplan-Meier分析、比例风险回归、逻辑回归和图表表示法分析CAPRA评分预测无复发生存率和病理肿瘤分期的准确性。

结果

对于CAPRA评分的外部验证,与CaPSURE数据集的原始队列相比,我们研究组的基础临床变量不利。在CAPRA评分为0至1组中,3年和5年后的无复发生存率分别从100%降至97%,在CAPRA评分为7或更高组中分别从44%降至31%。CAPRA总分每增加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至0.81之间,表明预测准确性良好。在5个CAPRA组成部分中,4个独立预测无复发生存率,即前列腺特异性抗原、Gleason评分总和、cT分期和阳性活检百分比。CAPRA评分为0至1的患者中,13.1%出现切缘阳性,而评分为7至10的患者中这一比例为62%(p<0.001)。CAPRA评分为0至1的患者中,97.7%存在器官局限性肿瘤,而评分为7至10的患者中这一比例为19.3%(p<0.001)。

结论

尽管本患者队列和CaPSURE数据集的临床特征不同,但CAPRA列线图预测无复发生存率的准确性较高。这些结果强调了CAPRA评分的有效性和临床适用性,除了用于患者咨询外,还可用于临床研究中的风险分层。

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