Schroeck Florian R, Aronson William J, Presti Joseph C, Terris Martha K, Kane Christopher J, Amling Christopher L, Freedland Stephen J
Division of Urologic Surgery, Department of Surgery, and Duke Prostate Center, Duke University Medical Center, Durham, NC 27710, USA.
BJU Int. 2009 Mar;103(5):603-8. doi: 10.1111/j.1464-410X.2008.08118.x. Epub 2008 Nov 18.
To compare the predictive accuracy (PA) of existing models in estimating risk of biochemical recurrence (BCR) vs aggressive recurrence (BCR with a prostate-specific antigen, PSA, doubling time, DT, of <9 months).
The study included 1550 men treated with radical prostatectomy (RP) between 1988 and 2007 within the Shared Equal Access Regional Cancer Hospital database. The PA of nine different risk stratification models for estimating risk of BCR and risk of aggressive recurrence after RP was assessed using the concordance index, c.
The 10-year risks of BCR and aggressive recurrence were 47% and 9%, respectively. Across all nine models tested, the PA was a mean (range) of 0.054 (0.024-0.074) points higher for predicting aggressive recurrence than for predicting BCR alone (c = 0.756 vs 0.702). Similar results were obtained in four sensitivity analyses: (i) defining patients with BCR but unavailable PSADT (220) as having aggressive recurrence; (ii) defining these patients as not having aggressive recurrence; (iii) defining aggressive recurrence as a PSADT of <6 months; or (iv) defining aggressive recurrence as a PSADT of <12 months. The improvement in PA was greater for preoperative than for postoperative models (0.053 vs 0.036, P = 0.03).
Across nine different models the prediction of aggressive recurrence after RP was more accurate than the prediction of BCR alone. This is probably because current models mainly assess cancer biology, which correlates better with aggressive recurrence than with BCR alone. Overall, all models had relatively similar accuracy for predicting aggressive recurrence.
比较现有模型在估计生化复发（BCR）风险与侵袭性复发（BCR且前列腺特异性抗原，PSA，倍增时间，DT，<9个月）风险方面的预测准确性（PA）。
该研究纳入了1988年至2007年期间在共享平等访问区域癌症医院数据库中接受根治性前列腺切除术（RP）的1550名男性。使用一致性指数c评估9种不同风险分层模型在估计RP后BCR风险和侵袭性复发风险方面的PA。
BCR和侵袭性复发的10年风险分别为47%和9%。在所有测试的9个模型中，预测侵袭性复发的PA比单独预测BCR的PA平均（范围）高0.054（0.024 - 0.074）分（c = 0.756对0.702）。在四项敏感性分析中获得了类似结果：（i）将有BCR但无法获得PSADT的患者（220例）定义为有侵袭性复发；（ii）将这些患者定义为没有侵袭性复发；（iii）将侵袭性复发定义为PSADT <6个月；或（iv）将侵袭性复发定义为PSADT <12个月。术前模型的PA改善大于术后模型（0.053对0.036，P = 0.03）。
在九个不同模型中，RP后侵袭性复发的预测比单独预测BCR更准确。这可能是因为当前模型主要评估癌症生物学，其与侵袭性复发的相关性比单独与BCR的相关性更好。总体而言，所有模型在预测侵袭性复发方面的准确性相对相似。
