Nguyen Paul L, Chen Ming-Hui, Hoffman Karen E, Katz Matthew S, D'Amico Anthony V
Harvard Radiation Oncology Program, Boston, MA, USA.
Int J Radiat Oncol Biol Phys. 2009 May 1;74(1):104-9. doi: 10.1016/j.ijrobp.2008.07.053. Epub 2009 Mar 13.
The "Roach formula" for the risk of pelvic lymph node metastases [(2/3) ( *) PSA + (Gleason score - 6) ( *) 10] was developed in the early prostate-specific antigen (PSA) era. We examined the accuracy of this formula in contemporary patients.
We included men in the Surveillance, Epidemiology, and End Results Registry with a diagnosis of clinical T1c-T4 prostate cancer in 2004 who had a surgical lymph node evaluation, Gleason score (typically from prostatectomy), and baseline PSA level (n = 9,387). Expected and observed rates of node positivity were compared.
Ninety-eight percent were clinical T1c/T2, and 97% underwent prostatectomy. Overall, 309 patients (3.29%) had positive lymph nodes. Roach scores overestimated the actual rate of positive lymph nodes in the derivation set by 16-fold for patients with Roach score less than or equal to 10%, by 7-fold for scores greater than 10-20%, and by approximately 2.5-fold for scores greater than 20%. Applying these adjustment factors to Roach scores in the validation data set yielded accurate predictions of risk. For those with Roach score less than or equal to 10%, adjusted expected risk was 0.2% and observed risk was 0.2%. For Roach score greater than 10-20%, adjusted expected risk was 2.0% and observed risk was 2.1%. For Roach score greater than 20-30%, adjusted expected risk was 9.7% and observed risk was 6.5%. For Roach score greater than 30-40%, adjusted expected risk was 13.9% and observed risk was 13.9%.
Applied to contemporary patients with mainly T1c/T2 disease, the Roach formula appears to overestimate pelvic lymph node risk. The adjustment factors presented here should be validated by using biopsy Gleason scores and extended lymphadenectomies.
“罗奇公式”用于评估盆腔淋巴结转移风险[（2/3）×前列腺特异抗原（PSA）+（ Gleason评分 - 6）×10]，是在早期前列腺特异抗原（PSA）时代制定的。我们检验了该公式在当代患者中的准确性。
我们纳入了2004年监测、流行病学和最终结果登记处中诊断为临床T1c - T4期前列腺癌且接受了手术淋巴结评估、Gleason评分（通常来自前列腺切除术）和基线PSA水平的男性患者（n = 9387）。比较了淋巴结阳性的预期发生率和观察到的发生率。
98%为临床T1c/T2期，97%接受了前列腺切除术。总体而言，309例患者（3.29%）有阳性淋巴结。对于罗奇评分小于或等于10%的患者，罗奇评分在推导组中高估了实际阳性淋巴结率16倍；对于评分大于10% - 20%的患者，高估了7倍；对于评分大于20%的患者，高估了约2.5倍。将这些调整因子应用于验证数据集中的罗奇评分可得出准确的风险预测。对于罗奇评分小于或等于10%的患者，调整后的预期风险为0.2%，观察到的风险为0.2%。对于罗奇评分大于10% - 20%的患者，调整后的预期风险为2.0%，观察到的风险为2.1%。对于罗奇评分大于20% - 30%的患者，调整后的预期风险为9.7%，观察到的风险为6.5%。对于罗奇评分大于30% - 40%的患者，调整后的预期风险为13.9%，观察到的风险为13.9%。
应用于当代主要为T1c/T2期疾病的患者时，罗奇公式似乎高估了盆腔淋巴结转移风险。此处提出的调整因子应通过使用活检Gleason评分和扩大淋巴结清扫术进行验证。
