Park Jae Young, Yoon Sungroh, Park Man Sik, Choi Hoon, Bae Jae Hyun, Moon Du Geon, Hong Sung Kyu, Lee Sang Eun, Park Chanwang, Byun Seok-Soo
Department of Urology, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Electrical and Computer Engineering, Seoul National University, Seoul, Republic of Korea.
PLoS One. 2017 Jan 3;12(1):e0168917. doi: 10.1371/journal.pone.0168917. eCollection 2017.
We developed the Korean Prostate Cancer Risk Calculator for High-Grade Prostate Cancer (KPCRC-HG) that predicts the probability of prostate cancer (PC) of Gleason score 7 or higher at the initial prostate biopsy in a Korean cohort (http://acl.snu.ac.kr/PCRC/RISC/). In addition, KPCRC-HG was validated and compared with internet-based Western risk calculators in a validation cohort.
Using a logistic regression model, KPCRC-HG was developed based on the data from 602 previously unscreened Korean men who underwent initial prostate biopsies. Using 2,313 cases in a validation cohort, KPCRC-HG was compared with the European Randomized Study of Screening for PC Risk Calculator for high-grade cancer (ERSPCRC-HG) and the Prostate Cancer Prevention Trial Risk Calculator 2.0 for high-grade cancer (PCPTRC-HG). The predictive accuracy was assessed using the area under the receiver operating characteristic curve (AUC) and calibration plots.
PC was detected in 172 (28.6%) men, 120 (19.9%) of whom had PC of Gleason score 7 or higher. Independent predictors included prostate-specific antigen levels, digital rectal examination findings, transrectal ultrasound findings, and prostate volume. The AUC of the KPCRC-HG (0.84) was higher than that of the PCPTRC-HG (0.79, p<0.001) but not different from that of the ERSPCRC-HG (0.83) on external validation. Calibration plots also revealed better performance of KPCRC-HG and ERSPCRC-HG than that of PCPTRC-HG on external validation. At a cut-off of 5% for KPCRC-HG, 253 of the 2,313 men (11%) would not have been biopsied, and 14 of the 614 PC cases with Gleason score 7 or higher (2%) would not have been diagnosed.
KPCRC-HG is the first web-based high-grade prostate cancer prediction model in Korea. It had higher predictive accuracy than PCPTRC-HG in a Korean population and showed similar performance with ERSPCRC-HG in a Korean population. This prediction model could help avoid unnecessary biopsy and reduce overdiagnosis and overtreatment in clinical settings.
我们开发了韩国高级别前列腺癌风险计算器（KPCRC-HG），用于预测韩国队列中初次前列腺活检时 Gleason 评分 7 分及以上的前列腺癌（PC）发生概率（http://acl.snu.ac.kr/PCRC/RISC/）。此外，对 KPCRC-HG 进行了验证，并在一个验证队列中与基于互联网的西方风险计算器进行了比较。
使用逻辑回归模型，基于 602 名先前未接受筛查且接受初次前列腺活检的韩国男性的数据开发了 KPCRC-HG。在一个验证队列中使用 2313 例病例，将 KPCRC-HG 与欧洲前列腺癌筛查随机研究高级别癌症风险计算器（ERSPCRC-HG）和前列腺癌预防试验高级别癌症风险计算器 2.0（PCPTRC-HG）进行比较。使用受试者操作特征曲线下面积（AUC）和校准图评估预测准确性。
在 172 名（28.6%）男性中检测到 PC，其中 120 名（19.9%）患有 Gleason 评分 7 分及以上的 PC。独立预测因素包括前列腺特异性抗原水平、直肠指检结果、经直肠超声检查结果和前列腺体积。在外部验证中，KPCRC-HG 的 AUC（0.84）高于 PCPTRC-HG（0.79，p<0.001），但与 ERSPCRC-HG（0.83）无差异。校准图也显示在外部验证中 KPCRC-HG 和 ERSPCRC-HG 的表现优于 PCPTRC-HG。对于 KPCRC-HG，在截断值为 5%时，2313 名男性中的 253 名（11%）本不会接受活检，614 例 Gleason 评分 7 分及以上的 PC 病例中的 14 例（2%）本不会被诊断出来。
KPCRC-HG 是韩国首个基于网络的高级别前列腺癌预测模型。在韩国人群中，它比 PCPTRC-HG 具有更高的预测准确性，并且在韩国人群中与 ERSPCRC-HG 表现相似。这种预测模型有助于避免不必要的活检，并减少临床环境中的过度诊断和过度治疗。
