Department of Urology, University of California, San Francisco, California, USA.
Cancer. 2011 Nov 15;117(22):5039-46. doi: 10.1002/cncr.26169. Epub 2011 Jun 3.
The authors previously developed and validated the Cancer of the Prostate Risk Assessment (CAPRA) score to predict prostate cancer recurrence based on pretreatment clinical data. They aimed to develop a similar postsurgical score with improved accuracy via incorporation of pathologic data.
A total of 3837 prostatectomy patients in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE™) national disease registry were analyzed. Cox regression was used to determine the predictive power of preoperative prostate-specific antigen (PSA), pathologic Gleason score (pGS), surgical margins (SM), extracapsular extension (ECE), seminal vesicle invasion (SVI), and lymph node invasion (LNI). Points were assigned based on the relative weights of these variables in predicting recurrence. The new postsurgical score (CAPRA-S) was tested and compared with a commonly cited nomogram with proportional hazards analysis, concordance (c) index, calibration plots, and decision-curve analysis.
Recurrence appeared in 16.8% of the men; actuarial progression-free probability at 5 years was 78.0%. The CAPRA-S was determined by adding up to 3 points for PSA, up to 3 points for pGS, 1 point each for ECE and LNI, and 2 points each for SM and SVI. The hazard ratio for each point increase in CAPRA-S score was 1.54 (95% confidence interval, 1.49-1.59), indicating a 2.4-fold increase in risk for each 2-point increase in score. The CAPRA-S c-index was 0.77, substantially higher than 0.66 for the pretreatment CAPRA score and comparable to 0.76 for the nomogram. The CAPRA-S score performed better in both calibration and decision curve analyses.
The CAPRA-S offers good discriminatory accuracy, calibration, and ease of calculation for clinical and research settings.
作者先前开发并验证了前列腺癌风险评估（CAPRA）评分，该评分基于治疗前的临床数据预测前列腺癌复发。他们旨在通过纳入病理数据来开发一种具有更高准确性的类似术后评分。
对癌症前列腺战略泌尿科研究努力（CaPSURE™）国家疾病登记处的 3837 例前列腺切除术患者进行了分析。Cox 回归用于确定术前前列腺特异性抗原（PSA）、病理 Gleason 评分（pGS）、手术切缘（SM）、包膜外延伸（ECE）、精囊侵犯（SVI）和淋巴结侵犯（LNI）的预测能力。根据这些变量在预测复发中的相对权重为其分配分数。新的术后评分（CAPRA-S）通过比例风险分析、一致性（c）指数、校准图和决策曲线分析进行了测试和比较。
16.8%的男性出现复发；5 年无进展生存概率为 78.0%。CAPRA-S 通过为 PSA 加 3 分、为 pGS 加 3 分、ECE 和 LNI 各加 1 分、SM 和 SVI 各加 2 分来确定。CAPRA-S 评分每增加 1 分，风险比为 1.54（95%置信区间，1.49-1.59），表明评分每增加 2 分，风险增加 2.4 倍。CAPRA-S 的 c 指数为 0.77，明显高于治疗前 CAPRA 评分的 0.66，与列线图的 0.76相当。CAPRA-S 评分在校准和决策曲线分析中表现更好。
CAPRA-S 在临床和研究环境中具有良好的判别准确性、校准和计算简便性。
