Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany.
UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany.
World J Urol. 2020 Mar;38(3):613-635. doi: 10.1007/s00345-018-2574-2. Epub 2018 Dec 15.
Prognostic models are developed to estimate the probability of the occurrence of future outcomes incorporating multiple variables. We aimed to identify and summarize existing multivariable prognostic models developed for predicting overall survival in patients with metastatic castration-resistant prostate cancer (mCRPC).
The protocol was prospectively registered (CRD42017064448). We systematically searched Medline and reference lists up to May 2018 and included experimental and observational studies, which developed and/or internally validated prognostic models for mCRPC patients and were further externally validated or updated. The outcome of interest was overall survival. Two authors independently performed literature screening and quality assessment.
We included 12 studies that developed models including 8750 patients aged 42-95 years. Models included 4-11 predictor variables, mostly hemoglobin, baseline PSA, alkaline phosphatase, performance status, and lactate dehydrogenase. Very few incorporated Gleason score. Two models included predictors related to docetaxel and mitoxantrone treatments. Model performance after internal validation showed similar discrimination power ranging from 0.62 to 0.73. Overall survival models were mainly constructed as nomograms or risk groups/score. Two models obtained an overall judgment of low risk of bias.
Most models were not suitable for clinical use due to methodological shortcomings and lack of external validation. Further external validation and/or model updating is required to increase prognostic accuracy and clinical applicability prior to their incorporation in clinical practice as a useful tool in patient management.
预后模型用于估计未来结果发生的概率，纳入多个变量。我们旨在确定和总结现有的用于预测转移性去势抵抗性前列腺癌（mCRPC）患者总体生存的多变量预后模型。
该方案前瞻性注册（CRD42017064448）。我们系统地检索了截至 2018 年 5 月的 Medline 和参考文献，并纳入了开发和/或内部验证了 mCRPC 患者预后模型的实验和观察性研究，并且进一步进行了外部验证或更新。主要结局是总生存。两位作者独立进行文献筛选和质量评估。
我们纳入了 12 项研究，这些研究建立了包括 8750 名年龄在 42-95 岁之间的患者的模型。模型纳入了 4-11 个预测变量，主要是血红蛋白、基线 PSA、碱性磷酸酶、表现状态和乳酸脱氢酶。很少有模型纳入了 Gleason 评分。有两个模型纳入了与多西他赛和米托蒽醌治疗相关的预测因素。内部验证后模型性能显示，判别能力相似，范围在 0.62 至 0.73 之间。总体生存模型主要构建为列线图或风险组/评分。有两个模型获得了低偏倚风险的总体判断。
由于方法学上的缺陷和缺乏外部验证，大多数模型不适合临床应用。在将其纳入临床实践作为患者管理的有用工具之前，需要进一步进行外部验证和/或模型更新，以提高预测准确性和临床适用性。
