Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Department of Surgery, Division of Urology, Geneva University Hospital, Geneva, Switzerland.
Chin Med J (Engl). 2021 Jun 16;134(13):1576-1583. doi: 10.1097/CM9.0000000000001607.
Various prediction tools have been developed to predict biochemical recurrence (BCR) after radical prostatectomy (RP); however, few of the previous prediction tools used serum prostate-specific antigen (PSA) nadir after RP and maximum tumor diameter (MTD) at the same time. In this study, a nomogram incorporating MTD and PSA nadir was developed to predict BCR-free survival (BCRFS).
A total of 337 patients who underwent RP between January 2010 and March 2017 were retrospectively enrolled in this study. The maximum diameter of the index lesion was measured on magnetic resonance imaging (MRI). Cox regression analysis was performed to evaluate independent predictors of BCR. A nomogram was subsequently developed for the prediction of BCRFS at 3 and 5 years after RP. Time-dependent receiver operating characteristic (ROC) curve and decision curve analyses were performed to identify the advantage of the new nomogram in comparison with the cancer of the prostate risk assessment post-surgical (CAPRA-S) score.
A novel nomogram was developed to predict BCR by including PSA nadir, MTD, Gleason score, surgical margin (SM), and seminal vesicle invasion (SVI), considering these variables were significantly associated with BCR in both univariate and multivariate analyses (P < 0.05). In addition, a basic model including Gleason score, SM, and SVI was developed and used as a control to assess the incremental predictive power of the new model. The concordance index of our model was slightly higher than CAPRA-S model (0.76 vs. 0.70, P = 0.02) and it was significantly higher than that of the basic model (0.76 vs. 0.66, P = 0.001). Time-dependent ROC curve and decision curve analyses also demonstrated the advantages of the new nomogram.
PSA nadir after RP and MTD based on MRI before surgery are independent predictors of BCR. By incorporating PSA nadir and MTD into the conventional predictive model, our newly developed nomogram significantly improved the accuracy in predicting BCRFS after RP.
已经开发出各种预测工具来预测根治性前列腺切除术（RP）后的生化复发（BCR）；然而，以前的预测工具中很少同时使用 RP 后血清前列腺特异性抗原（PSA）的最低值和最大肿瘤直径（MTD）。在这项研究中，开发了一个包含 MTD 和 PSA 最低值的列线图来预测无 BCR 生存（BCRFS）。
本研究回顾性纳入了 2010 年 1 月至 2017 年 3 月期间接受 RP 的 337 例患者。对磁共振成像（MRI）上的指数病变的最大直径进行测量。使用 Cox 回归分析评估 BCR 的独立预测因素。随后为 RP 后 3 年和 5 年的 BCRFS 预测开发了一个列线图。进行时间依赖性接受者操作特征（ROC）曲线和决策曲线分析，以确定新列线图与前列腺癌术后风险评估（CAPRA-S）评分相比的优势。
通过包括 PSA 最低值、MTD、Gleason 评分、手术切缘（SM）和精囊侵犯（SVI），开发了一种新的列线图来预测 BCR，考虑到这些变量在单变量和多变量分析中均与 BCR 显著相关（P<0.05）。此外，还开发了一个包含 Gleason 评分、SM 和 SVI 的基本模型，并用作对照，以评估新模型的增量预测能力。我们的模型的一致性指数略高于 CAPRA-S 模型（0.76 与 0.70，P=0.02），并且明显高于基本模型（0.76 与 0.66，P=0.001）。时间依赖性 ROC 曲线和决策曲线分析也表明了新列线图的优势。
RP 后 PSA 最低值和术前 MRI 上的 MTD 是 BCR 的独立预测因素。通过将 PSA 最低值和 MTD 纳入传统预测模型，我们新开发的列线图显著提高了预测 RP 后 BCRFS 的准确性。
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