Beckmann Kerri, O'Callaghan Michael, Vincent Andrew, Roder David, Millar Jeremy, Evans Sue, McNeil John, Moretti Kim
Centre for Population Health Research, School of Health Science, University of South Australia, Adelaide, South Australia, Australia.
South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC), Department of Urology, Repatriation General Hospital, Adelaide, South Australia, Australia.
ANZ J Surg. 2018 Mar;88(3):E183-E188. doi: 10.1111/ans.13954. Epub 2017 May 4.
The Cancer of the Prostate Risk Assessment Post-Surgical (CAPRA-S) score is a simple post-operative risk assessment tool predicting disease recurrence after radical prostatectomy, which is easily calculated using available clinical data. To be widely useful, risk tools require multiple external validations. We aimed to validate the CAPRA-S score in an Australian multi-institutional population, including private and public settings and reflecting community practice.
The study population were all men on the South Australian Prostate Cancer Clinical Outcomes Collaborative Database with localized prostate cancer diagnosed during 1998-2013, who underwent radical prostatectomy without adjuvant therapy (n = 1664). Predictive performance was assessed via Kaplan-Meier and Cox proportional regression analyses, Harrell's Concordance index, calibration plots and decision curve analysis.
Biochemical recurrence occurred in 342 (21%) cases. Five-year recurrence-free probabilities for CAPRA-S scores indicating low (0-2), intermediate (3-5) and high risk were 95, 79 and 46%, respectively. The hazard ratio for CAPRA-S score increments was 1.56 (95% confidence interval 1.49-1.64). The Concordance index for 5-year recurrence-free survival was 0.77. The calibration plot showed good correlation between predicted and observed recurrence-free survival across scores. Limitations include the retrospective nature and small numbers with higher CAPRA-S scores.
The CAPRA-S score is an accurate predictor of recurrence after radical prostatectomy in our cohort, supporting its utility in the Australian setting. This simple tool can assist in post-surgical selection of patients who would benefit from adjuvant therapy while avoiding morbidity among those less likely to benefit.
前列腺癌术后风险评估（CAPRA - S）评分是一种简单的术后风险评估工具，用于预测根治性前列腺切除术后疾病复发情况，可利用现有临床数据轻松计算得出。为了广泛应用，风险评估工具需要多次外部验证。我们旨在对澳大利亚多机构人群中的CAPRA - S评分进行验证，该人群包括私立和公立机构，反映社区实际情况。
研究人群为南澳大利亚前列腺癌临床结局协作数据库中在1998 - 2013年期间被诊断为局限性前列腺癌且接受了根治性前列腺切除术且未接受辅助治疗的所有男性（n = 1664）。通过Kaplan - Meier法和Cox比例回归分析、Harrell一致性指数、校准图和决策曲线分析来评估预测性能。
342例（21%）出现生化复发。CAPRA - S评分显示低风险（0 - 2）、中风险（3 - 5）和高风险的五年无复发生存概率分别为95%、79%和46%。CAPRA - S评分增加的风险比为1.56（95%置信区间1.49 - 1.64）。五年无复发生存的一致性指数为0.77。校准图显示各评分的预测无复发生存与观察到的无复发生存之间具有良好相关性。局限性包括研究的回顾性性质以及CAPRA - S评分较高的病例数量较少。
在我们的队列中，CAPRA - S评分是根治性前列腺切除术后复发的准确预测指标，支持其在澳大利亚环境中的实用性。这个简单的工具可以帮助在术后选择能从辅助治疗中获益的患者，同时避免那些不太可能获益的患者出现并发症。
