Department of Urology, Fudan University, Shanghai Cancer Center, Shanghai 200032, China.
Asian J Androl. 2012 Sep;14(5):738-44. doi: 10.1038/aja.2012.28. Epub 2012 May 7.
Several prediction models have been developed to estimate the outcomes of prostate biopsies. Most of these tools were designed for use with Western populations and have not been validated across different ethnic groups. Therefore, we evaluated the predictive value of the Prostate Cancer Prevention Trial (PCPT) and the European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculators in a Chinese cohort. Clinicopathological information was obtained from 495 Chinese men who had undergone extended prostate biopsies between January 2009 and March 2011. The estimated probabilities of prostate cancer and high-grade disease (Gleason >6) were calculated using the PCPT and ERSPC risk calculators. Overall measures, discrimination, calibration and clinical usefulness were assessed for the model evaluation. Of these patients, 28.7% were diagnosed with prostate cancer and 19.4% had high-grade disease. Compared to the PCPT model and the prostate-specific antigen (PSA) threshold of 4 ng ml(-1), the ERSPC risk calculator exhibited better discriminative ability for predicting positive biopsies and high-grade disease (the area under the curve was 0.831 and 0.852, respectively, P<0.01 for both). Decision curve analysis also suggested the favourable clinical utility of the ERSPC calculator in the validation dataset. Both prediction models demonstrated miscalibration: the risk of prostate cancer and high-grade disease was overestimated by approximately 20% for a wide range of predicted probabilities. In conclusion, the ERSPC risk calculator outperformed both the PCPT model and the PSA threshold of 4 ng ml(-1) in predicting prostate cancer and high-grade disease in Chinese patients. However, the prediction tools derived from Western men significantly overestimated the probability of prostate cancer and high-grade disease compared to the outcomes of biopsies in a Chinese cohort.
已经开发出了几种预测模型来估计前列腺活检的结果。这些工具大多数是为西方人群设计的，并没有在不同的种族群体中进行验证。因此，我们评估了前列腺癌预防试验（PCPT）和欧洲前列腺癌筛查随机研究（ERSPC）风险计算器在中国人群中的预测价值。临床病理信息来自于 2009 年 1 月至 2011 年 3 月期间接受扩展前列腺活检的 495 名中国男性。使用 PCPT 和 ERSPC 风险计算器计算前列腺癌和高级别疾病（Gleason>6）的估计概率。评估了模型评估的整体措施、区分度、校准和临床实用性。这些患者中，28.7%被诊断为前列腺癌，19.4%患有高级别疾病。与 PCPT 模型和前列腺特异性抗原（PSA）阈值 4ng/ml（-1）相比，ERSPC 风险计算器在预测阳性活检和高级别疾病方面具有更好的区分能力（曲线下面积分别为 0.831 和 0.852，两者均<0.01）。决策曲线分析还表明，ERSPC 计算器在验证数据集中具有有利的临床实用性。两种预测模型都表现出校准不足：对于广泛的预测概率，前列腺癌和高级别疾病的风险被高估了约 20%。总之，ERSPC 风险计算器在预测中国患者的前列腺癌和高级别疾病方面优于 PCPT 模型和 PSA 阈值 4ng/ml（-1）。然而，与中国人群的活检结果相比，源自西方男性的预测工具显著高估了前列腺癌和高级别疾病的概率。
