Eggener Scott E, Vickers Andrew J, Serio Angel M, Donovan Michael J, Khan Faisal M, Bayer-Zubek Valentina, Verbel David, Cordon-Cardo Carlos, Reuter Victor E, Bianco Fernando J, Scardino Peter T
Section of Urology, University of Chicago, Chicago, Illinois, USA.
Cancer. 2009 Jan 15;115(2):303-10. doi: 10.1002/cncr.24016.
Models are available to accurately predict biochemical disease recurrence (BCR) after radical prostatectomy (RP). Because not all patients experiencing BCR will progress to metastatic disease, it is appealing to determine postoperatively which patients are likely to manifest systemic disease.
The study cohort consisted of 881 patients undergoing RP between 1985 and 2003. Clinical failure (CF) was defined as metastases, a rising prostate-specific antigen (PSA) in a castrate state, or death from prostate cancer. The cohort was randomized into training and validation sets. The accuracy of 4 models to predict clinical outcome within 5 years of RP were compared: 'postoperative BCR nomogram' and 'Cox regression CF model' based on standard clinical and pathologic parameters, and 2 CF 'systems pathology' models that integrate clinical and pathologic parameters with quantitative histomorphometric and immunofluorescent biomarker features ('systems pathology Models 1 and 2').
When applied to the validation set, the concordance index for the postoperative BCR nomogram was 0.85, for the Cox regression CF model 0.84, for systems pathology Model 1 0.81, and for systems pathology Model 2 0.85.
Models predicting either BCR or CF after RP exhibit similarly high levels of accuracy because standard clinical and pathologic variables appear to be the primary determinants of both outcomes. It is possible that introducing current or novel biomarkers found to be uniquely associated with disease progression may further enhance the accuracy of the systems pathology-based platform.
现有模型可准确预测根治性前列腺切除术后的生化疾病复发（BCR）。由于并非所有经历BCR的患者都会进展为转移性疾病，因此确定术后哪些患者可能出现全身性疾病很有吸引力。
研究队列包括1985年至2003年间接受根治性前列腺切除术的881例患者。临床失败（CF）定义为转移、去势状态下前列腺特异性抗原（PSA）升高或前列腺癌死亡。该队列被随机分为训练集和验证集。比较了4种模型预测根治性前列腺切除术后5年内临床结局的准确性：基于标准临床和病理参数的“术后BCR列线图”和“Cox回归CF模型”，以及2种将临床和病理参数与定量组织形态计量学和免疫荧光生物标志物特征相结合的CF“系统病理学”模型（“系统病理学模型1和2”）。
应用于验证集时，术后BCR列线图的一致性指数为0.85，Cox回归CF模型为0.84，系统病理学模型1为0.81，系统病理学模型2为0.85。
预测根治性前列腺切除术后BCR或CF的模型表现出相似的高准确性，因为标准临床和病理变量似乎是这两种结局的主要决定因素。引入目前发现的或新的与疾病进展独特相关的生物标志物可能会进一步提高基于系统病理学的平台的准确性。
