Glickman Urological and Kidney Institute and the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
BJU Int. 2010 Feb;105(3):352-8. doi: 10.1111/j.1464-410X.2009.08778.x. Epub 2009 Aug 13.
Diagnostic (exploratory cohort).
2b.
To develop a nomogram to predict the probability that the pathological Gleason sum (GS) will be higher than that indicated by the biopsy, suggesting a higher risk for the patient presumed to be at low risk, as a substantial proportion of patients with low and intermediate grade on biopsy are upgraded on interpretation of the radical prostatectomy (RP) specimens, but a similar clarification of accurate Gleason scoring is not available in patients with no surgical histology.
The study included 1017 patients who had RP after biopsy showing GS 6 and 7 (3 + 4) from 2000 to 2007. Nomogram predictor variables included age, race, digital rectal examination, prostate-specific antigen (PSA) level, number of cores taken, number of positive cores, maximum percentage cancer in any core, number of previous biopsies, prostate volume, clinical stage, high-grade prostatic intraepithelial neoplasia, atypical small acinar proliferation, inflammation and perineural invasion. We calculated the nomogram-predicted probability in each patient. The area under the receiver operating characteristic curve was calculated as a measure of discrimination, and the calibration was assessed graphically.
The mean age of the patients was 60 years, the mean PSA level 6.62 ng/mL; 336 patients were upgraded (33%), 623 remained the same (61.3%) and 58 were downgraded (5.7%). A nomogram for predicting the possibility of upgrading was constructed that had a concordance index of 0.68. The nomogram was well calibrated.
Our nomogram for predicting upgrading provides important additional information for deciding on treatment to both the urologist and the patient with low- and intermediate-grade prostate cancer. It might prove useful when the possibility of a more aggressive Gleason variant can change the management, and is especially meaningful when management options other than surgery are selected based on the inability to recognize the true pathological actual GS.
诊断（探索性队列）。
2b。
建立一个列线图来预测病理 Gleason 总和（GS）高于活检预测值的概率，提示假定为低危的患者存在更高的风险，因为活检中相当一部分低级别和中级别患者在解读根治性前列腺切除术（RP）标本时会升级，但对于没有手术组织学的患者，类似的明确 Gleason 评分准确性的方法并不适用。
本研究纳入了 2000 年至 2007 年间接受 RP 的 1017 例活检显示 GS 6 和 7（3+4）的患者。列线图预测变量包括年龄、种族、直肠指检、前列腺特异性抗原（PSA）水平、取芯数、阳性芯数、任何芯中最大癌症百分比、既往活检次数、前列腺体积、临床分期、高级别前列腺上皮内瘤变、不典型小腺泡增生、炎症和神经周围侵犯。我们计算了每位患者的列线图预测概率。计算了接收者操作特征曲线下面积作为区分度的衡量标准，并通过图形评估校准。
患者的平均年龄为 60 岁，平均 PSA 水平为 6.62ng/ml；336 例患者升级（33%），623 例患者保持不变（61.3%），58 例患者降级（5.7%）。构建了一个预测升级可能性的列线图，其一致性指数为 0.68。该列线图具有良好的校准度。
我们预测升级的列线图为低级别和中级别前列腺癌的泌尿科医生和患者提供了重要的额外信息，以帮助他们决定治疗方案。当更具侵袭性的 Gleason 变体的可能性会改变治疗方案时，它可能会证明有用，当由于无法识别真实的病理实际 GS 而选择手术以外的治疗方案时，它尤其有意义。
