Lin Guo-Wen, Ye Ding-Wei, Jia Hui-Xun, Dai Bo, Zhang Hai-Liang, Zhu Yao, Shi Guo-Hai, Ma Chun-Guang
Department of Urology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China ; Department of Clinical Statistics Center, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China.
Onco Targets Ther. 2015 Apr 7;8:713-9. doi: 10.2147/OTT.S77013. eCollection 2015.
The optimal time to perform bone scan to detect new metastasis during the castration-resistant prostate cancer (CRPC) stage remains undefined. This study attempted to identify predictors of progression of bone scan for CRPC, and use such information to develop a nomogram to predict the optimal time of examinations for bone scan. The analysis included 167 CRPC patients. Progression of bone lesion, as evaluated by bone scan, occurred in 64 (38.3%) cases. A logistic regression identified the following three risk factors: short time to prostate-specific antigen (PSA) progression, severe pain, and short PSA doubling time (PSADT) (P<0.05 for all). A nomogram model was constructed to predict progression of bone scan using time to PSA progression and severe pain as dichotomized variables and PSADT as a continuous variable. The result indicated that a predictive nomogram model showed a bootstrap-corrected concordance index of 0.762 and good calibration using the three readily available variables, and there were worse prognosis and higher progression rate of bone scan for patients with time to PSA progression <6.6 months, severe pain, and short PSADT (<2 months). In conclusion, short time to PSA progression, severe pain, and short PSADT are three risk factors of progression of bone scan for CRPC patients. The predictive nomogram model may be a valuable numerical assessment tool for patient consultation and treatment decision.
在去势抵抗性前列腺癌（CRPC）阶段，进行骨扫描以检测新转移灶的最佳时间仍不明确。本研究试图确定CRPC患者骨扫描进展的预测因素，并利用这些信息制定列线图，以预测骨扫描的最佳检查时间。分析纳入了167例CRPC患者。经骨扫描评估，64例（38.3%）出现骨病变进展。逻辑回归确定了以下三个风险因素：前列腺特异性抗原（PSA）进展时间短、严重疼痛和PSA加倍时间（PSADT）短（所有P<0.05）。构建了一个列线图模型，将PSA进展时间和严重疼痛作为二分变量，PSADT作为连续变量来预测骨扫描进展。结果表明，预测列线图模型的自举校正一致性指数为0.762，使用这三个易于获得的变量具有良好的校准，对于PSA进展时间<6.6个月、严重疼痛和PSADT短（<2个月）的患者，骨扫描的预后较差且进展率较高。总之，PSA进展时间短、严重疼痛和PSADT短是CRPC患者骨扫描进展的三个风险因素。预测列线图模型可能是用于患者咨询和治疗决策的有价值的数值评估工具。
