Suardi Nazareno, Porter Christopher R, Reuther Alwyn M, Walz Jochen, Kodama Koichi, Gibbons Robert P, Correa Roy, Montorsi Francesco, Graefen Markus, Huland Hartwig, Klein Eric A, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
Cancer. 2008 Mar 15;112(6):1254-63. doi: 10.1002/cncr.23293.
Men who undergo radical prostatectomy (RP) are at long-term risk of biochemical recurrence (BCR). In this report, the authors have described a model capable of predicting BCR up to at least 15 years after RP that can adjust predictions according to the disease-free interval.
Cox regression was used to model the probability of BCR (a prostate-specific antigen level>0.1 ng/mL and rising) in 601 men who underwent RP with a median follow-up of 11.4 years. The statistical significance of nomogram predictors was confirmed with a competing-risks regression model. The model was validated internally with 200 bootstraps and externally at 5 years, 10 years, and 15 years in 2 independent cohorts of 2963 and 3178 contemporary RP patients from 2 institutions.
The 5-year, 10-year, 15-year, and 20-year actuarial rates of BCR-free survival were 84.8%, 71.2%, 61.1%, and 58.6%, respectively. Pathologic stage, surgical margin status, pathologic Gleason sum, type of RP, and adjuvant radiotherapy represented independent predictors of BCR in both Cox and competing-risks regression models and constituted the nomogram predictor variables. In internal validation, the nomogram accuracy was 79.3%, 77.2%, 79.7%, and 80.6% at 5 years, 10 years, 15 years, and 20 years, respectively, after RP. In external validation, the nomogram was 77.4% accurate at 5 years in the first cohort and 77.9%, 79.4%, and 86.3% accurate at 5 years, 10 years, and 15 years, respectively, in the second cohort.
Patients who undergo RP remain at risk of BCR beyond 10 years after RP. The nomogram described in this report distinguishes itself from other tools by its ability to accurately predict the conditional probability of BCR up to at least 15 years after surgery.
接受根治性前列腺切除术（RP）的男性存在生化复发（BCR）的长期风险。在本报告中，作者描述了一种能够预测RP后至少15年内BCR的模型，该模型可根据无病间隔调整预测。
采用Cox回归对601例接受RP的男性的BCR（前列腺特异性抗原水平>0.1 ng/mL且呈上升趋势）概率进行建模，中位随访时间为11.4年。用竞争风险回归模型确认列线图预测因子的统计学意义。该模型在内部通过200次自抽样验证，并在来自2个机构的2963例和3178例当代RP患者的2个独立队列中，于5年、10年和15年进行外部验证。
无BCR生存的5年、10年、15年和20年精算率分别为84.8%、71.2%、61.1%和58.6%。病理分期、手术切缘状态、病理Gleason评分、RP类型和辅助放疗在Cox回归模型和竞争风险回归模型中均为BCR的独立预测因子，并构成列线图预测变量。在内部验证中，RP后5年、10年、15年和20年列线图的准确率分别为79.3%、77.2%、79.7%和80.6%。在外部验证中，第一个队列中列线图在5年时的准确率为77.4%，第二个队列中列线图在5年、10年和15年时的准确率分别为77.9%、79.4%和86.3%。
接受RP的患者在RP后10年以上仍有BCR风险。本报告中描述的列线图与其他工具的不同之处在于，它能够准确预测术后至少15年内BCR的条件概率。
