Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, People's Republic of China.
Department of Urology, Affiliated Hospital of Yunnan University (The Second People's Hospital of Yunnan Province, Ophthalmic Hospital of Yunnan Province), Kunming, Yunnan, People's Republic of China.
Sci Rep. 2023 Oct 18;13(1):17719. doi: 10.1038/s41598-023-44911-z.
Prostate Cancer (PC) is the most common male nonskin tumour in the world, and most diagnosed patients are over 65 years old. The main treatment for PC includes surgical treatment and nonsurgical treatment. Currently, for nonsurgically treated elderly patients, few studies have evaluated their prognostic factors. Our aim was to construct a nomogram that could predict cancer-specific survival (CSS) in nonsurgically treated elderly PC patients to assess their prognosis-related independent risk factors. Patient information was obtained from the Surveillance, Epidemiology and End Results (SEER) database, and our target population was nonsurgically treated PC patients who were over 65 years old. Independent risk factors were determined using both univariate and multivariate Cox regression models. A nomogram was built using a multivariate Cox regression model. The accuracy and discrimination of the prediction model were tested using the consistency index (C-index), the area under the subject operating characteristic curve (AUC), and the calibration curve. Decision curve analysis (DCA) was used to examine the potential clinical value of this model. A total of 87,831 elderly PC patients with nonsurgical treatment in 2010-2018 were included in the study and were randomly assigned to the training set (N = 61,595) and the validation set (N = 26,236). Univariate and multivariate Cox regression model analyses showed that age, race, marital status, TNM stage, chemotherapy, radiotherapy modality, PSA and GS were independent risk factors for predicting CSS in nonsurgically treated elderly PC patients. The C-index of the training set and the validation set was 0.894 (95% CI 0.888-0.900) and 0.897 (95% CI 0.887-0.907), respectively, indicating the good discrimination ability of the nomogram. The AUC and the calibration curves also show good accuracy and discriminability. We developed a new nomogram to predict CSS in elderly PC patients with nonsurgical treatment. The model is internally validated with good accuracy and reliability, as well as potential clinical value, and can be used for clinical aid in decision-making.
前列腺癌（PC）是世界上最常见的男性非皮肤肿瘤，大多数诊断出的患者年龄超过 65 岁。PC 的主要治疗方法包括手术治疗和非手术治疗。目前，对于非手术治疗的老年患者，很少有研究评估其预后因素。我们的目的是构建一个列线图，以预测非手术治疗的老年 PC 患者的癌症特异性生存（CSS），以评估其与预后相关的独立风险因素。患者信息来自监测、流行病学和最终结果（SEER）数据库，我们的目标人群是非手术治疗的年龄超过 65 岁的 PC 患者。使用单因素和多因素 Cox 回归模型确定独立风险因素。使用多因素 Cox 回归模型构建列线图。使用一致性指数（C 指数）、受试者工作特征曲线下面积（AUC）和校准曲线测试预测模型的准确性和区分度。决策曲线分析（DCA）用于检查该模型的潜在临床价值。共纳入 2010-2018 年 87831 例非手术治疗的老年 PC 患者，随机分为训练集（N=61595）和验证集（N=26236）。单因素和多因素 Cox 回归模型分析显示，年龄、种族、婚姻状况、TNM 分期、化疗、放疗方式、PSA 和 GS 是预测非手术治疗老年 PC 患者 CSS 的独立危险因素。训练集和验证集的 C 指数分别为 0.894（95%CI 0.888-0.900）和 0.897（95%CI 0.887-0.907），表明该列线图具有良好的区分能力。AUC 和校准曲线也显示出良好的准确性和区分能力。我们开发了一种新的列线图来预测非手术治疗的老年 PC 患者的 CSS。该模型具有良好的准确性和可靠性，内部验证结果良好，具有潜在的临床价值，可用于临床辅助决策。
