Format

Send to

Choose Destination
Prostate. 2017 Jun;77(8):928-933. doi: 10.1002/pros.23348. Epub 2017 Apr 2.

External validation of a nomogram for identification of pathologically favorable disease in intermediate risk prostate cancer patients.

Author information

1
Department of Urology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
2
Department of Statistics, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France.
3
Ospedale San Raffaele, Milano, Lombardia, Italy.
4
Centre Hospitalier Regional Universitaire de Lille, Lille, France.
5
Department of Urology, CHU Mondor, Créteil, France.
6
Department of Urology, Vita-Salute University San Raffaele, Milan, Italy.
7
Clinique St Jean du Languedoc, Toulouse, France.
8
Institut Mutualiste Montsouris, Paris, France.

Abstract

OBJECTIVE:

To establish an external validation of the new nomogram from Gandaglia et al which provides estimates of the probability of pathological favorable disease in pre-operatively defined intermediate-risk PCa.

PATIENTS AND METHODS:

Overall, 2928 intermediate-risk PCa patients according to the D'Amico classification undergoing RP and bilateral lymph node dissection in seven academic centres between 2000 and 2011. Pathologically favorable PCa was defined as low-grade organ-confined disease. The Receiver Operating Characteristic (ROC) curve was obtained to quantify the overall accuracy (Area Under the Curve, AUC) of the model to predict specimen-confined (SC) disease. Calibration curve was then constructed to illustrate the relationship between the risk-estimates obtained by the model and the observed proportion of SC disease. Kaplan-Meier method was used for PSA recurrence-free survival (PSA-RFS) assessment.

RESULTS:

Median age was 68 years. 10.6% patients finally presented pathologically favorable disease characteristics at RP. A higher PSAD (OR = 0.01; 95%CI = 0.00-0.04; P < 0.0001) and percentage of positive cores (OR = 0.97; 95%CI = 0.96-0.98; P < 0.0001) were associated with a reduced probability of favorable disease at RP in multivariate analysis. ROC curve analysis showed strongest accuracy of the model (AUC = 0.82; 95%CI = 0.79-0.84). Favorable PCa had a significantly better PSA recurrence-free survival rates as compared to unfavorable PCa after RP (94.2% vs 74.4% at 4 years, P < 0.0001).

CONCLUSIONS:

This external validation of the Gandaglia nomogram shows relevant accuracy with one out of ten patients in this intermediate risk PCa group with pathologically proven organ-confined disease. This validated risk calculator can help physician to distinguish favorable intermediate risk PCa that can be treated by conservative approach or safer nerve-sparing surgery.

KEYWORDS:

biochemical recurrence; disease; favorable; final pathology; intermediate-risk prostate cancer; nomogram; radical prostatectomy

PMID:
28370267
DOI:
10.1002/pros.23348
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center