Secin Fernando P, Bianco Fernando J, Cronin Angel, Eastham James A, Scardino Peter T, Guillonneau Bertrand, Vickers Andrew J
Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers and Department of Epidemiology and Biostatistics (AC, AJV), Memorial Sloan-Kettering Cancer Center, New York, New York.
J Urol. 2009 Feb;181(2):609-13; discussion 614. doi: 10.1016/j.juro.2008.10.035. Epub 2008 Dec 13.
A publication on behalf of the European Society of Urological Oncology questioned the need for removing the seminal vesicles during radical prostatectomy in patients with prostate specific antigen less than 10 ng/ml except when biopsy Gleason score is greater than 6 or there are greater than 50% positive biopsy cores. We applied the European Society of Urological Oncology algorithm to an independent data set to determine its predictive value.
Data on 1,406 men who underwent radical prostatectomy and seminal vesicle removal between 1998 and 2004 were analyzed. Patients with and without seminal vesicle invasion were classified as positive or negative according to the European Society of Urological Oncology algorithm.
Of 90 cases with seminal vesicle invasion 81 (6.4%) were positive for 90% sensitivity, while 656 of 1,316 without seminal vesicle invasion were negative for 50% specificity. The negative predictive value was 98.6%. In decision analytic terms if the loss in health when seminal vesicles are invaded and not completely removed is considered at least 75 times greater than when removing them unnecessarily, the algorithm proposed by the European Society of Urological Oncology should not be used.
Whether to use the European Society of Urological Oncology algorithm depends not only on its accuracy, but also on the relative clinical consequences of false-positive and false-negative results. Our threshold of 75 is an intermediate value that is difficult to interpret, given uncertainties about the benefit of seminal vesicle sparing and harm associated with untreated seminal vesicle invasion. We recommend more formal decision analysis to determine the clinical value of the European Society of Urological Oncology algorithm.
一篇代表欧洲泌尿肿瘤学会发表的文章质疑，对于前列腺特异性抗原低于10 ng/ml的患者，除活检Gleason评分大于6或活检阳性核心大于50%的情况外，在根治性前列腺切除术中是否有必要切除精囊。我们将欧洲泌尿肿瘤学会的算法应用于一个独立数据集，以确定其预测价值。
分析了1998年至2004年间1406例行根治性前列腺切除术并切除精囊的男性患者的数据。根据欧洲泌尿肿瘤学会的算法，将有或无精囊侵犯的患者分类为阳性或阴性。
在90例有精囊侵犯的病例中，81例（6.4%）为阳性，敏感性为90%，而在1316例无精囊侵犯的病例中，656例为阴性，特异性为50%。阴性预测值为98.6%。从决策分析的角度来看，如果精囊受到侵犯且未完全切除时的健康损失被认为至少比不必要地切除精囊时大75倍，则不应使用欧洲泌尿肿瘤学会提出的算法。
是否使用欧洲泌尿肿瘤学会的算法不仅取决于其准确性，还取决于假阳性和假阴性结果的相对临床后果。鉴于保留精囊的益处和未治疗的精囊侵犯相关危害存在不确定性，我们设定的75这个阈值是一个难以解释的中间值。我们建议进行更正式的决策分析，以确定欧洲泌尿肿瘤学会算法的临床价值。
