Zheng Fuchun, Li Sheng, Wan Xianwen, Wang Zhipeng, Xiong Situ, Liu Xiaoqiang, Fu Bin
Department of Urology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
Jiangxi Institute of Urology, Nanchang, China.
Gland Surg. 2024 Nov 30;13(11):2137-2147. doi: 10.21037/gs-24-313. Epub 2024 Nov 26.
Metastatic prostate cancer (mPCa) complicates treatment due to its unpredictable progression. Current prognostic tools often lack precision. This study aimed to develop an effective tool to predict overall survival (OS) in mPCa patients undergoing radiotherapy, thereby addressing the clinical need for personalized treatment decisions.
A total of 1,171 mPCa patients receiving radiotherapy between 2004 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Patients with distant metastases and complete data on prostate-specific antigen (PSA), Gleason score (GS), and tumor-node-metastasis (TNM) staging were included. The cohort was randomly divided into a training set (n=819) and an internal validation set (n=352). Independent prognostic factors, including age, marital status, PSA, GS, T-stage, M-stage, and chemotherapy, were used to construct a nomogram. The external validation cohort comprised 138 mPCa patients from The First Affiliated Hospital of Nanchang University, with survival outcomes followed through their medical records.
In the SEER cohort, 67.7% of patients were married, 74.3% were White, and 23.2% had a GS of 7. The external validation cohort had a mean survival of 45.8 months. The nomogram's area under the curve (AUC) values for predicting 1-, 3-, and 5-year OS were 0.686, 0.679, and 0.724 in the training cohort; 0.713, 0.732, and 0.711 in the internal validation cohort; and 0.748, 0.735, and 0.750 in the external validation cohort, respectively. Calibration plots demonstrated reasonable agreement between predicted and observed survival rates, but the AUC values indicate moderate predictive performance.
Although the nomogram offers some clinical value in estimating survival for mPCa patients receiving radiotherapy, its predictive accuracy remains moderate. Further refinements incorporating additional prognostic factors may enhance its clinical utility.
转移性前列腺癌（mPCa）因其不可预测的进展而使治疗变得复杂。当前的预后工具往往缺乏精准度。本研究旨在开发一种有效的工具来预测接受放疗的mPCa患者的总生存期（OS），从而满足个性化治疗决策的临床需求。
从监测、流行病学和最终结果（SEER）数据库中选取了2004年至2015年间共1171例接受放疗的mPCa患者。纳入有远处转移且具备前列腺特异性抗原（PSA）、 Gleason评分（GS）和肿瘤-淋巴结-转移（TNM）分期完整数据的患者。该队列被随机分为训练集（n = 819）和内部验证集（n = 352）。使用包括年龄、婚姻状况、PSA、GS、T分期、M分期和化疗在内的独立预后因素构建列线图。外部验证队列包括来自南昌大学第一附属医院的138例mPCa患者，通过病历追踪其生存结局。
在SEER队列中，67.7%的患者已婚，74.3%为白人，23.2%的GS评分为7。外部验证队列的平均生存期为45.8个月。在训练队列中，列线图预测1年、3年和5年OS的曲线下面积（AUC）值分别为0.686、0.679和0.724；在内部验证队列中分别为0.713、0.732和0.711；在外部验证队列中分别为0.748、0.735和0.750。校准图显示预测生存率与观察生存率之间具有合理的一致性，但AUC值表明预测性能中等。
尽管列线图在估计接受放疗的mPCa患者的生存期方面具有一定的临床价值，但其预测准确性仍然中等。纳入更多预后因素的进一步改进可能会提高其临床实用性。
