Department of Surgery, Oncology and Gastroenterology - Urology, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
Department of Pathology, Azienda Ospedaliera di Padova/University of Padova, Padova, Italy.
Aging Clin Exp Res. 2018 Dec;30(12):1497-1504. doi: 10.1007/s40520-018-0949-2. Epub 2018 May 2.
Prostate cancer (PC) represents the second most frequent cancer in the male population worldwide. It is mandatory to have a very accurate staging to choice the best possible treatment.
To test the possibility of improving the performance of Partin's tables in predicting the pathological staging of PC by introducing bioptic parameters through an innovative statistic tool (Fagan's two-step nomogram).
We prospectivelly collected data of all 1048 consecutive patients undergoing saturation 24-core transrectal prostate biopsy. Then, in eligible 94 patients, we compared the prediction of presence/absence of extracapsular extension of neoplasm (EPE+/-), with pathological assessment of invasion through (pseudo)capsule in the prostatectomy specimens. Starting from the probability of EPE- (pre-test probability, calculated with formula "100%-risk of EPE+"), we used Fagan's nomogram to examine the diagnostic sensitivity (DSe) and specificity (DSp) of negative "lateral" bioptic cores.
We specifically analyzed the status of "lateral" cores in each side (94 patients × 2 sides = 188 sides). "Lateral" cores were negative in 42.5% of sides (80/188) with a DSe and DSp of 91.7 and 45.4%, respectively. In these sides, the mean probability of EPE+ according to Partin's tables was 21.6%. With Fagan's nomogram, the post-test probability of EPE+ when all "lateral" cores were negative was 14.1%, with a substantial gain of 7.5%.
The spatial distribution of bioptic positive cores allowed us to demonstrate the role Fagan's nomogram in increasing the accuracy of already existing, predictive tools for PC.
This pioneering study may justify the use of the above nomogram in testing "local" predictive parameters in combination with pre-existing nomograms.
前列腺癌（PC）是全球男性人群中第二大常见癌症。为了选择最佳治疗方案，进行非常准确的分期是强制性的。
通过引入创新的统计工具（Fagan 的两步列线图）中的活检参数，测试改善 Partin 表预测 PC 病理分期的性能的可能性。
我们前瞻性地收集了所有 1048 例连续接受 24 芯经直肠前列腺饱和活检的患者的数据。然后，在 94 例合格患者中，我们比较了通过前列腺切除术标本中包膜（假性）侵犯来预测肿瘤是否存在或不存在包膜外延伸（EPE+/-）的预测。从 EPE-的概率（通过公式“100%-EPE+风险”计算得出的术前概率）开始，我们使用 Fagan 的列线图来检查阴性“外侧”活检核心的诊断敏感性（DSe）和特异性（DSp）。
我们专门分析了每一侧（94 例患者×2 侧=188 侧）“外侧”核心的状态。80/188 侧（42.5%）的“外侧”核心为阴性，DSe 和 DSp 分别为 91.7%和 45.4%。在这些侧，根据 Partin 表，EPE+的平均概率为 21.6%。使用 Fagan 的列线图，当所有“外侧”核心均为阴性时，EPE+的后验概率为 14.1%，显著增加了 7.5%。
活检阳性核心的空间分布使我们能够证明 Fagan 列线图在提高 PC 已有预测工具的准确性方面的作用。
这项开创性的研究可能证明在与现有列线图结合使用时，上述列线图可以用于测试“局部”预测参数。
