Nakanishi Hiroyuki, Wang Xuemei, Ochiai Atsushi, Trpkov Kiril, Yilmaz Asli, Donnelly J Bryan, Davis John W, Troncoso Patricia, Babaian R Joseph
Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2007 Dec 1;110(11):2441-7. doi: 10.1002/cncr.23055.
The authors reported previously that assessment of the number of positive biopsy cores, maximum tumor length in a core, Gleason score, and prostate volume in an extended biopsy enhanced the accuracy of predicting low-volume/low-grade prostate cancer. On the basis of those findings, they developed a nomogram to predict the probability of low-volume/low-grade prostate cancer specifically for men with a single positive biopsy core.
The study cohort comprised 258 men who underwent radical prostatectomy without neoadjuvant therapy. Prostate cancer was diagnosed in only 1 core of an extended biopsy scheme. Low-volume/low-grade cancer was defined as pathologic organ-confined disease and a tumor volume<0.5 cc with no Gleason grade 4 or 5 cancer. Patient age, prostate-specific antigen (PSA) level, prostate volume, PSA density (PSAD), and tumor length in a biopsy core were examined as variables. A fitted multiple logistic regression model was used to establish the nomogram.
One hundred thirty-three patients (51.6%) had low-volume/low-grade cancer. To establish the nomogram, age, PSAD, and tumor length were adopted as variables. The fitted model suggested that older age, higher PSAD values, and greater tumor length would reduce the probability of low-volume/low-grade cancer. The nomogram predicted low-volume/low-grade cancer with good discrimination (an area under the receiver operating characteristic curve of 0.727). Calibration of this nomogram showed good predicted probability.
The authors established a nomogram with which to predict low-volume/low-grade cancer in men with 1 positive biopsy core in an extended biopsy scheme, and they recommend this nomogram for use in selecting men for active surveillance.
作者之前报道过，在扩展活检中评估阳性活检芯数量、芯内最大肿瘤长度、 Gleason评分和前列腺体积可提高预测低体积/低级别前列腺癌的准确性。基于这些发现，他们开发了一种列线图，专门用于预测单个阳性活检芯男性患者发生低体积/低级别前列腺癌的概率。
研究队列包括258例未接受新辅助治疗而行根治性前列腺切除术的男性。前列腺癌仅在扩展活检方案的1个芯中被诊断出来。低体积/低级别癌症被定义为病理上局限于器官的疾病，肿瘤体积<0.5 cc，且无Gleason 4级或5级癌症。将患者年龄、前列腺特异性抗原（PSA）水平、前列腺体积、PSA密度（PSAD）和活检芯内肿瘤长度作为变量进行研究。采用拟合多元逻辑回归模型建立列线图。
133例患者（51.6%）患有低体积/低级别癌症。为建立列线图，采用年龄、PSAD和肿瘤长度作为变量。拟合模型表明，年龄较大、PSAD值较高和肿瘤长度较大将降低低体积/低级别癌症的概率。该列线图对低体积/低级别癌症的预测具有良好的辨别力（受试者操作特征曲线下面积为0.727）。该列线图的校准显示出良好的预测概率。
作者建立了一种列线图，用于预测扩展活检方案中单个阳性活检芯男性患者的低体积/低级别癌症，并建议将此列线图用于选择进行主动监测的男性患者。
