Molina Escudero Roberto, Herranz Amo Felipe, Paez Borda Alvaro, Hernández Fernández Carlos
Servicio de Urologia. Hospital Universitario Fuenlabrada. Madrid. Servicio de Urologia. Hospital Universitario Gregorio Marañón. Madrid. España.
Arch Esp Urol. 2013 Jul-Aug;66(6):567-75.
To identify pre-prostatectomy clinical prognostic factors for biochemical recurrence (BR) and to create a predictive model for BR based or predictive clinical variables prior to radical prostatectomy (RP).
a retrospective case-records study of patients with clinically localized prostate cancer treated with RPas monotherapy pN0-pNx and monitored at least for 12 months between 1996 and 2007. We considered BR the PSA persistence or elevation after RP greater than 0.4 ng/ml. The clinical variables analyzed were PSA, clinical stage and Gleason score from the biopsy (GS). Univariate and multivariate analysis were carried out using the chi squared test and logistic regression to determine the variables associated with BR. In order to estimate BR based on the variables identified we developed a mathematical model and designed an Excel spreadsheet to apply it. Calibration and discrimination were performed using the Hosmer-Lemeshow test and an ROC curve determining the area under the curve.
We included 627 patients. The mean age was 64 years with a mean follow- up of 87 months. The mean PSA was 8 ng/ml. 68.6% of patients had a PSA ≤ 10 ng/ml, 53,1% had a GS ≤ 6 and 61,7% had a clinical stage of cT1a-c. BR was observed in 204 (32,5%) patients, 39 due to biochemical persistence. The mean time to BR was 28 months with 89,7% of instances occurring in the first 8 years. On the multivariate analysis, PSA and GS were independent predictors of BR ( p=0.001), while the cT2c stage had a tendency towards statistical significance ( p=0.06). The three variables were included in the equation for the model with different specific weight. Specificity was 93.6%, sensitivity was 36.8% and an overall precision of 75.1%. The model had a predictive capacity of 73% and a p-value < 0.001.
PSA and GS are independent prognostic clinical variables associated with BR-free survival. The predictive model developed allows the risk of BR to be estimated with 73% reliability.
确定前列腺切除术前生化复发（BR）的临床预后因素，并基于根治性前列腺切除术（RP）前的临床预测变量创建BR预测模型。
对1996年至2007年间接受RP单一疗法治疗且pN0 - pNx临床局限性前列腺癌患者进行回顾性病例记录研究，并至少监测12个月。我们将RP后PSA持续存在或升高至大于0.4 ng/ml视为BR。分析的临床变量包括活检的PSA、临床分期和 Gleason评分（GS）。使用卡方检验和逻辑回归进行单变量和多变量分析，以确定与BR相关的变量。为了基于所确定的变量估计BR，我们开发了一个数学模型并设计了一个Excel电子表格来应用它。使用Hosmer-Lemeshow检验和确定曲线下面积的ROC曲线进行校准和区分。
我们纳入了627例患者。平均年龄为64岁，平均随访87个月。平均PSA为8 ng/ml。68.6%的患者PSA≤10 ng/ml，53.1%的患者GS≤6，61.7%的患者临床分期为cT1a - c。204例（32.5%）患者出现BR，其中39例因生化持续存在。BR的平均时间为28个月，89.7%的情况发生在前8年。多变量分析显示，PSA和GS是BR的独立预测因素（p = 0.001），而cT2c期有统计学意义的趋势（p = 0.06）。这三个变量以不同的特定权重纳入模型方程。特异性为93.6%，敏感性为36.8%，总体精度为75.1%。该模型的预测能力为73%，p值<0.001。
PSA和GS是与无BR生存相关的独立预后临床变量。所开发的预测模型能够以73%的可靠性估计BR风险。
