Raymond Elspeth, O'Callaghan Michael E, Campbell Jared, Vincent Andrew D, Beckmann Kerri, Roder David, Evans Sue, McNeil John, Millar Jeremy, Zalcberg John, Borg Martin, Moretti Kim
South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC), Adelaide, Australia.
Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, Australia.
Radiat Oncol. 2017 Mar 21;12(1):56. doi: 10.1186/s13014-017-0786-z.
Prostate cancer can be treated with several different modalities, including radiation treatment. Various prognostic tools have been developed to aid decision making by providing estimates of the probability of different outcomes. Such tools have been demonstrated to have better prognostic accuracy than clinical judgment alone.
A systematic review was undertaken to identify papers relating to the prediction of clinical outcomes (biochemical failure, metastasis, survival) in patients with prostate cancer who received radiation treatment, with the particular aim of identifying whether published tools are adequately developed, validated, and provide accurate predictions. PubMed and EMBASE were searched from July 2007. Title and abstract screening, full text review, and critical appraisal were conducted by two reviewers. A review protocol was published in advance of commencing literature searches.
The search strategy resulted in 165 potential articles, of which 72 were selected for full text review and 47 ultimately included. These papers described 66 models which were newly developed and 31 which were external validations of already published predictive tools. The included studies represented a total of 60,457 patients, recruited between 1984 and 2009. Sixty five percent of models were not externally validated, 57% did not report accuracy and 31% included variables which are not readily accessible in existing datasets. Most models (72, 74%) related to external beam radiation therapy with the remainder relating to brachytherapy (alone or in combination with external beam radiation therapy).
A large number of prognostic models (97) have been described in the recent literature, representing a rapid increase since previous reviews (17 papers, 1966-2007). Most models described were not validated and a third utilised variables which are not readily accessible in existing data collections. Where validation had occurred, it was often limited to data taken from single institutes in the US. While validated and accurate models are available to predict prostate cancer specific mortality following external beam radiation therapy, there is a scarcity of such tools relating to brachytherapy. This review provides an accessible catalogue of predictive tools for current use and which should be prioritised for future validation.
前列腺癌可以通过多种不同的方式进行治疗，包括放射治疗。已经开发了各种预后工具，通过提供不同结果概率的估计来辅助决策。这些工具已被证明比单纯的临床判断具有更好的预后准确性。
进行了一项系统综述，以识别与接受放射治疗的前列腺癌患者临床结局（生化失败、转移、生存）预测相关的论文，特别目的是确定已发表的工具是否经过充分开发、验证并提供准确预测。从2007年7月开始检索PubMed和EMBASE。由两名评审员进行标题和摘要筛选、全文审查以及批判性评价。在开始文献检索之前预先发布了综述方案。
检索策略产生了165篇潜在文章，其中72篇被选进行全文审查，最终纳入47篇。这些论文描述了66个新开发的模型和31个已发表预测工具的外部验证模型。纳入的研究共涉及1984年至2009年招募的60457名患者。65%的模型未进行外部验证，57%未报告准确性，31%纳入了现有数据集中不易获取的变量。大多数模型（72个，74%）与外照射放疗相关，其余与近距离放疗（单独或与外照射放疗联合）相关。
最近的文献中描述了大量的预后模型（97个），与之前的综述（1966 - 2007年的17篇论文）相比有快速增加。所描述的大多数模型未经验证，三分之一使用了现有数据收集中不易获取的变量。在进行验证的情况下，通常仅限于来自美国单个机构的数据。虽然有经过验证且准确的模型可用于预测外照射放疗后的前列腺癌特异性死亡率，但与近距离放疗相关的此类工具却很少。本综述提供了一份当前可用的预测工具目录，这些工具应优先进行未来验证。
