Urology Division, University of São Paulo Medical School, São Paulo, Brazil and Cancer Institute of Sao Paulo, São Paulo, Brazil.
Int Braz J Urol. 2014 Mar-Apr;40(2):161-71. doi: 10.1590/S1677-5538.IBJU.2014.02.05.
(a) To externally validate the Crippa and colleagues' nomograms combining PSA, percentage of positive biopsy cores (PPBC) and biopsy Gleason score to predict organ-confined disease (OCD) in a contemporary sample of patients treated at a tertiary teaching institution. (b) To adjust such variables, resulting in predictive nomograms for OCD and seminal vesicle invasion (SVI): the USP nomograms.
The accuracy of Crippa and colleagues' nomograms for OCD prediction was examined in 1002 men submitted to radical prostatectomy between 2005 and 2010 at the University of São Paulo (USP). ROC-derived area under the curve (AUC) and Brier scores were used to assess the discriminant properties of nomograms for OCD. Nomograms performance was explored graphically with LOESS smoothing plots. Furthermore, univariate analysis and logistic regression models targeted OCD and SVI. Variables consisted of PSA, PPBC, biopsy Gleason score and clinical stage. The resulted predictive nomograms for OCD and SVI were internally validated with bootstrapping and the same abovementioned procedures.
Crippa and colleagues' nomograms for OCD showed ROC AUC = 0.68 (CI: 0.65-0.70), Brier score = 0.17 and overestimation in LOESS plots. USP nomograms for OCDand SVI showed ROC AUC of 0.73 (CI: 0.70-0.76) and 0.77 (CI: 0.73-0.79), respectively, and Brier scores of 0.16 and 0.08, respectively. The LOESS plots showed excellent calibration for OCD and underestimation for SVI.
Crippa and colleagues' nomograms showed moderate discrimination and considerable OCD overestimation. USP nomograms showed good discrimination for OCD and SVI, as well as excellent calibration for OCD and SVI underestimation.
（a）在一个在三级教学机构接受治疗的当代患者样本中，对外验证 Crippa 及其同事的列线图，该列线图结合 PSA、阳性活检核心百分比（PPBC）和活检 Gleason 评分来预测器官局限性疾病（OCD）。（b）调整这些变量，为 OCD 和精囊侵犯（SVI）生成预测列线图：USP 列线图。
在 2005 年至 2010 年期间，在圣保罗大学（USP）接受根治性前列腺切除术的 1002 名男性中，检查了 Crippa 及其同事的列线图预测 OCD 的准确性。ROC 衍生的曲线下面积（AUC）和 Brier 评分用于评估列线图对 OCD 的判别性能。通过 LOESS 平滑图直观地探索了列线图的性能。此外，进行了单变量分析和逻辑回归模型以针对 OCD 和 SVI。变量包括 PSA、PPBC、活检 Gleason 评分和临床分期。使用 Bootstrap 和上述相同程序对 OCD 和 SVI 的预测列线图进行了内部验证。
Crippa 及其同事的 OCD 列线图的 ROC AUC 为 0.68（CI：0.65-0.70），Brier 评分 0.17，LOESS 图中存在高估。USP 的 OCD 和 SVI 列线图的 ROC AUC 分别为 0.73（CI：0.70-0.76）和 0.77（CI：0.73-0.79），Brier 评分分别为 0.16 和 0.08。LOESS 图显示 OCD 具有出色的校准，而 SVI 则存在低估。
Crippa 及其同事的列线图显示出中等的区分度和 OCD 的高估。USP 列线图对 OCD 和 SVI 具有良好的区分度，对 OCD 和 SVI 的低估具有出色的校准。
