Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
Prostate Cancer Prostatic Dis. 2018 Sep;21(3):386-393. doi: 10.1038/s41391-018-0033-1. Epub 2018 Feb 27.
Early biochemical recurrence (eBCR) after radical prostatectomy (RP) heralds poor oncological outcomes and may be prevented with adjuvant radiation (aRT).
We developed a contemporary eBCR nomogram in 13 797 RP patients from Hamburg (2005-2016) and externally validated it in 5952 RP patients from Vienna. Receiver operating characteristics-derived area under the curve (AUC), Heagerty's C-index, and decision curve analysis (DCA) were used to quantify model accuracy and to compare the current tool with the Walz nomogram, the online Memorial Sloan Kettering Cancer Center (MSKCC) nomogram and the post-surgical Cancer of the Prostate Risk Assesment (CAPRA-S).
The eBCR nomogram relies on independent BCR predictors at 12 and 24 months after RP: preoperative PSA, pathological Gleason Score, tumor stage, lymph node, and surgical margin status. It achieved 81% accuracy at both time points in external validation. Additionally, the current nomogram yielded best calibration, optimal DCA results, and highest rates of avoided aRT in cutoff analyses, compared to the Walz nomogram, the MSKCC nomogram, and the CAPRA-S score.
The updated eBCR nomogram is easily applicable, highly accurate, and may allow avoiding immediate aRT in a large proportion of patients with few concomitant missed eBCR instances. It compares favorably to similar tools.
根治性前列腺切除术（RP）后早期生化复发（eBCR）预示着较差的肿瘤学结局，并且可以通过辅助放疗（aRT）来预防。
我们在来自汉堡的 13797 例 RP 患者（2005-2016 年）中开发了一个当代的 eBCR 列线图，并在来自维也纳的 5952 例 RP 患者中进行了外部验证。接收者操作特征曲线（ROC）下面积（AUC）、Heagerty 的 C 指数和决策曲线分析（DCA）用于量化模型准确性，并比较当前工具与 Walz 列线图、在线 Memorial Sloan Kettering 癌症中心（MSKCC）列线图和术后前列腺癌风险评估（CAPRA-S）。
eBCR 列线图依赖于 RP 后 12 个月和 24 个月的独立 BCR 预测因素：术前 PSA、病理 Gleason 评分、肿瘤分期、淋巴结和手术切缘状态。在外部验证中，它在两个时间点的准确性均达到 81%。此外，与 Walz 列线图、MSKCC 列线图和 CAPRA-S 评分相比，当前列线图在临界值分析中具有最佳的校准、最佳的 DCA 结果和最高的避免 aRT 比例。
更新的 eBCR 列线图易于应用、高度准确，并可能允许在很大一部分患者中避免立即进行 aRT，而不会错过少数 eBCR 事件。它与类似的工具相比具有优势。
