Tissugen Pty Ltd, University of Western Australia, Perth, Western Australia.
J Urol. 2011 Nov;186(5):1811-7. doi: 10.1016/j.juro.2011.06.060. Epub 2011 Sep 25.
We designed and fully evaluated the performance of a nomogram to identify patients with prostate cancer who may be suitable for active surveillance.
We developed a nomogram to predict the probability of minimal prostate cancer (total tumor volume less than 0.5 cc, organ confined disease and no Gleason pattern 4 or 5) using preoperative data on 2,525 Australian patients who underwent radical prostatectomy. Accuracy and error rates at multiple probability cutoffs were compared with those of contemporary Epstein criteria and the Prostate Cancer Research International: Active Surveillance trial inclusion criteria when applied to these patients. High risk disease was defined as 1 or more adverse characteristics (including positive surgical margins, seminal vesicle invasion, extracapsular extension, 50% or greater Gleason pattern 4/5 and/or tumor volume 4.0 cc or greater) at radical prostatectomy.
Minimal cancer was confirmed in 152 men (6.0%) at prostatectomy. The bootstrap corrected predictive accuracy of our nomogram was 93.3% vs 89.1% and 91.0% for Prostate Cancer Research International: Active Surveillance and Epstein criteria, respectively. For men with a nomogram derived minimal cancer probability of 0% to 4.9%, 5.0% to 19.9%, 20.0% to 34.9%, 35.0% to 49.9% and 50.0% to 71.0% the rate of high risk disease was 70.8%, 37.8%, 22.4%, 9.0% and 3.8%, respectively. In contrast, the rate of high risk disease for men who met Prostate Cancer Research International: Active Surveillance and Epstein criteria were 17.1% and 13.9%, respectively.
A detailed breakdown of the expected rates of false-positive results and high risk disease associated with the nomogram derived probability of minimal cancer would provide more complete information to clinicians and patients on which to base therapeutic clinical decisions for presumed early stage prostate cancer.
我们设计并全面评估了一种列线图的性能，以确定可能适合主动监测的前列腺癌患者。
我们使用 2525 名接受根治性前列腺切除术的澳大利亚患者的术前数据，开发了一种预测微小前列腺癌（总肿瘤体积小于 0.5cc，器官受限疾病且无 Gleason 模式 4 或 5）概率的列线图。在这些患者中，将其与当代 Epstein 标准和前列腺癌研究国际：主动监测试验纳入标准的多个概率截断值的准确性和误差率进行了比较。高风险疾病定义为根治性前列腺切除术后存在 1 种或多种不良特征（包括阳性手术切缘、精囊侵犯、包膜外延伸、50%或更高的 Gleason 模式 4/5 和/或肿瘤体积 4.0cc 或更大）。
在前列腺切除术中，152 名患者（6.0%）证实存在微小癌。我们的列线图的 bootstrap 校正预测准确性分别为 93.3%、89.1%和 91.0%，用于前列腺癌研究国际：主动监测和 Epstein 标准。对于列线图预测微小癌概率为 0%至 4.9%、5.0%至 19.9%、20.0%至 34.9%、35.0%至 49.9%和 50.0%至 71.0%的男性，高风险疾病的发生率分别为 70.8%、37.8%、22.4%、9.0%和 3.8%。相比之下，符合前列腺癌研究国际：主动监测和 Epstein 标准的男性高风险疾病的发生率分别为 17.1%和 13.9%。
详细分析列线图预测微小癌概率的假阳性结果和高风险疾病的预期发生率，将为临床医生和患者提供更完整的信息，以便根据假定的早期前列腺癌做出治疗临床决策。
