Division of Orthopaedics, Department of Surgery, Uniformed Services University, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
The Henry Jackson Foundation for the Advancement of Sciences, 6720A Rockledge Dr, Suite 100, Bethesda, MD, 20817, USA.
BMC Cancer. 2022 Apr 30;22(1):476. doi: 10.1186/s12885-022-09491-7.
Prognostic indicators, treatments, and survival estimates vary by cancer type. Therefore, disease-specific models are needed to estimate patient survival. Our primary aim was to develop models to estimate survival duration after treatment for skeletal-related events (SREs) (symptomatic bone metastasis, including impending or actual pathologic fractures) in men with metastatic bone disease due to prostate cancer. Such disease-specific models could be added to the PATHFx clinical-decision support tool, which is available worldwide, free of charge. Our secondary aim was to determine disease-specific factors that should be included in an international cancer registry.
We analyzed records of 438 men with metastatic prostate cancer who sustained SREs that required treatment with radiotherapy or surgery from 1989-2017. We developed and validated 6 models for 1-, 2-, 3-, 4-, 5-, and 10-year survival after treatment. Model performance was evaluated using calibration analysis, Brier scores, area under the receiver operator characteristic curve (AUC), and decision curve analysis to determine the models' clinical utility. We characterized the magnitude and direction of model features.
The models exhibited acceptable calibration, accuracy (Brier scores < 0.20), and classification ability (AUCs > 0.73). Decision curve analysis determined that all 6 models were suitable for clinical use. The order of feature importance was distinct for each model. In all models, 3 factors were positively associated with survival duration: younger age at metastasis diagnosis, proximal prostate-specific antigen (PSA) < 10 ng/mL, and slow-rising alkaline phosphatase velocity (APV).
We developed models that estimate survival duration in patients with metastatic bone disease due to prostate cancer. These models require external validation but should meanwhile be included in the PATHFx tool. PSA and APV data should be recorded in an international cancer registry.
不同癌症类型的预后指标、治疗方法和生存估计值各不相同。因此，需要针对特定疾病的模型来估计患者的生存情况。我们的主要目标是开发模型，以估计因前列腺癌导致的转移性骨病患者发生骨骼相关事件（SREs）（包括即将发生或实际发生的病理性骨折的症状性骨转移）后的生存时间。此类特定于疾病的模型可以添加到 PATHFx 临床决策支持工具中，该工具在全球范围内免费提供。我们的次要目标是确定应包含在国际癌症登记处的特定于疾病的因素。
我们分析了 1989 年至 2017 年间 438 名发生需要接受放疗或手术治疗的 SREs 的转移性前列腺癌男性患者的记录。我们开发并验证了 6 个模型，用于预测治疗后 1 年、2 年、3 年、4 年、5 年和 10 年的生存情况。使用校准分析、Brier 评分、接受者操作特征曲线下面积（AUC）和决策曲线分析来评估模型性能，以确定模型的临床实用性。我们描述了模型特征的大小和方向。
这些模型表现出可接受的校准度、准确性（Brier 评分<0.20）和分类能力（AUC>0.73）。决策曲线分析确定所有 6 个模型均适用于临床使用。每个模型的特征重要性顺序均不同。在所有模型中，有 3 个因素与生存时间呈正相关：转移诊断时的年龄较小、前列腺特异性抗原（PSA）<10ng/mL 和碱性磷酸酶（AP）增速较慢。
我们开发了用于估计因前列腺癌导致的转移性骨病患者生存时间的模型。这些模型需要外部验证，但同时应包含在 PATHFx 工具中。PSA 和 APV 数据应记录在国际癌症登记处。
