Walz Jochen, Chun Felix K-H, Klein Eric A, Reuther Alwyn, Saad Fred, Graefen Markus, Huland Hartwig, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada.
J Urol. 2009 Feb;181(2):601-7; discussion 607-8. doi: 10.1016/j.juro.2008.10.033. Epub 2008 Dec 13.
We developed a nomogram predicting the probability of early biochemical recurrence after radical prostatectomy because early recurrence predisposes to distant metastasis and prostate cancer related mortality. Identifying patients at risk for early recurrence may improve prognosis as early institution of adjuvant therapy may reduce the risk of progression.
From January 1992 to December 2005, 2,911 patients underwent radical prostatectomy for localized prostate cancer. Cox regression models addressing biochemical recurrence after radical prostatectomy were used to identify significant predictors. Age, prostate specific antigen, pathological Gleason sum, surgical margin, extracapsular extension, seminal vesicle invasion and lymph node invasion were considered. A nomogram predicting the probability of biochemical recurrence-free survival within 2 years after radical prostatectomy was developed. Data from an independent center were used for external validation (2,875).
In both cohorts combined during the first 2 years 11.0% (639) of all patients experienced relapse which accounted for 58.5% of all observed biochemical recurrence. In the development cohort except for age all covariates represented significant predictors of biochemical recurrence after radical prostatectomy. Pathological Gleason sum 7 or greater, seminal vesicle invasion and lymph node invasion were the most powerful predictors of biochemical recurrence. The accuracy (c-index) of the nomogram predicting biochemical recurrence-free survival within 2 years after radical prostatectomy was 0.82 in the external validation cohort.
Two-thirds of all instances of relapse occur during the first 2 years after radical prostatectomy. Those patients can be highly accurately identified with our nomogram. They might benefit the most from adjuvant treatment and could be the ideal candidates for adjuvant treatment trials.
我们开发了一种列线图，用于预测根治性前列腺切除术后早期生化复发的概率，因为早期复发易导致远处转移和前列腺癌相关死亡。识别有早期复发风险的患者可能会改善预后，因为尽早进行辅助治疗可能会降低疾病进展的风险。
从1992年1月至2005年12月，2911例患者因局限性前列腺癌接受了根治性前列腺切除术。使用Cox回归模型分析根治性前列腺切除术后的生化复发情况，以确定显著的预测因素。考虑的因素包括年龄、前列腺特异性抗原、病理Gleason评分、手术切缘、包膜外侵犯、精囊侵犯和淋巴结侵犯。开发了一种列线图，用于预测根治性前列腺切除术后2年内无生化复发生存的概率。来自一个独立中心的数据用于外部验证（2875例）。
在前2年合并的两个队列中，所有患者中有11.0%（639例）出现复发，占所有观察到的生化复发的58.5%。在开发队列中，除年龄外，所有协变量均为根治性前列腺切除术后生化复发的显著预测因素。病理Gleason评分为7分或更高、精囊侵犯和淋巴结侵犯是生化复发的最强预测因素。在外部验证队列中，预测根治性前列腺切除术后2年内无生化复发生存的列线图的准确性（c指数）为0.82。
所有复发病例中有三分之二发生在根治性前列腺切除术后的前2年。使用我们的列线图可以高度准确地识别这些患者。他们可能从辅助治疗中获益最大，并且可能是辅助治疗试验的理想候选者。
