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977 Postoperative nomogram predicting the probability of biochemical recurrence after radical prostatectomy for prostate cancer
977 - Postoperative nomogram predicting the probability of biochemical recurrence after ... Page 1 of 2
e977 Postoperative nomogram predicting the probability of biochemical recurrence after radical prostatectomy for prostate cancer 1
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Allué M. , Borque A. , Esteban L.M. , Sanz G. , Del Amo J. , Ponz 6
R. , Morote J. 1 2 3
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Vall Hebron University Hospital, Dept. of Urology, Barcelona, Spain, Miguel Servet University Hospital, Dept. of Urology, Zaragoza, Spain, University of Zaragoza, Almunia Polytechnic University School, 4
Zaragoza, Spain, University of Zaragoza, Dept. of Statistical Methods, Zaragoza, Spain,
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Progenika Biopharma S.A., Dept. of Genetic 6
Research, Bilbao, Spain, Covance Clinical and Periapproval Services S.A., Dept. of Clinical Research, Barcelona, Spain INTRODUCTION & OBJECTIVES: Different nomograms to predict biochemical relapse published previously assumed the importance of create more accurate models that included new variables. We pretend to developed a postoperative nomogram that allows accurate prediction of biochemical recurrence probability at 2, 5 and 10 years. Aiming to improve the prediction, we increased the clinical and pathological variables analyzed, in comparison with the models previously published. MATERIAL & METHODS: We performed a retrospective study of 429 patients treated with radical prostatectomy for clinically localized prostate cancer. Biochemical relapse was defined as a rising prostatespecific antigen (PSA) level >0.4 ng/mL. Patients without biochemical relapse had at least 5 years of follow up after surgery. Multivariable analysis were performed using Cox regression model. Discrimination was measured by the concordance index. Prognostic variables included were age, clinical stage, PSA, PSA density, PSA density of the transition zone, prostate volume, adenoma volume, number of prostate biopsy cores, percentage of positive biopsy cores, percentage
file://F:\RamShankar\April\04-05-12\Cip\Sour\977.html
4/7/2012
977 - Postoperative nomogram predicting the probability of biochemical recurrence after ... Page 2 of 2
e977a of positive biopsy tissue, biopsy Gleason score, biopsy primary Gleason grade, biopsy secondary Gleason grade, tumoral volume, prostate weight, pathological stage, prostate Gleason score, prostate primary Gleason grade, prostate secondary Gleason grade, perineural invasion, linfovascular invasion, multicentricity, oncologic surgical margins, glandular surgical margins and lymph node involvement. Our nomograme has been compared with Stephenson-Kattan nomograme using Concordane index (C index). RESULTS: The overall biochemical recurrence rate was 36.7%. The univariate study showed association with biochemical relapse of every variable analyzed except age , prostate and adenoma volume, number of prostate biopsy cores and multicentricity. Significant variables in the multivariate model included PSA (p=0.003), pathologic stage (p<0.0001), pathologic Gleason score (p<0.0001), oncologic surgical margins (p<0.0001), glandular surgical margins (p=0.005). The predictions from our nomogram appeared to be more accurate and discriminating than Stephenson-Kattan nomograme for the studied sample of patients (C index=0.757 vs 0.704). The calibration plot showed close agreement between biochemical recurrence observed and predicted probabilities. Decision curve analysis was used to select the probability cutoffs that allows to classificate patients into low, intermediate o high risk of biochemical recurrence after surgery. CONCLUSIONS: The postoperative nomogram developed can predict the probability of disease recurrence at 2, 5 and 10 years after radical prostatectomy. The nomogram may be useful in daily practice assisting the physician and the patient in deciding whether adjuvant therapy is and acceptable treatment option or if more frequent PSA controls after surgery could be done.
file://F:\RamShankar\April\04-05-12\Cip\Sour\977.html
4/7/2012
e977 Postoperative nomogram predicting the probability of biochemical recurrence after radical prostatectomy for prostate cancer 1
2
3
4
5
Allué M. , Borque A. , Esteban L.M. , Sanz G. , Del Amo J. , Ponz 6
R. , Morote J. 1 2 3
1
Vall Hebron University Hospital, Dept. of Urology, Barcelona, Spain, Miguel Servet University Hospital, Dept. of Urology, Zaragoza, Spain, University of Zaragoza, Almunia Polytechnic University School, 4
Zaragoza, Spain, University of Zaragoza, Dept. of Statistical Methods, Zaragoza, Spain,
5
Progenika Biopharma S.A., Dept. of Genetic 6
Research, Bilbao, Spain, Covance Clinical and Periapproval Services S.A., Dept. of Clinical Research, Barcelona, Spain INTRODUCTION & OBJECTIVES: Different nomograms to predict biochemical relapse published previously assumed the importance of create more accurate models that included new variables. We pretend to developed a postoperative nomogram that allows accurate prediction of biochemical recurrence probability at 2, 5 and 10 years. Aiming to improve the prediction, we increased the clinical and pathological variables analyzed, in comparison with the models previously published. MATERIAL & METHODS: We performed a retrospective study of 429 patients treated with radical prostatectomy for clinically localized prostate cancer. Biochemical relapse was defined as a rising prostatespecific antigen (PSA) level >0.4 ng/mL. Patients without biochemical relapse had at least 5 years of follow up after surgery. Multivariable analysis were performed using Cox regression model. Discrimination was measured by the concordance index. Prognostic variables included were age, clinical stage, PSA, PSA density, PSA density of the transition zone, prostate volume, adenoma volume, number of prostate biopsy cores, percentage of positive biopsy cores, percentage
file://F:\RamShankar\April\04-05-12\Cip\Sour\977.html
4/7/2012
977 - Postoperative nomogram predicting the probability of biochemical recurrence after ... Page 2 of 2
e977a of positive biopsy tissue, biopsy Gleason score, biopsy primary Gleason grade, biopsy secondary Gleason grade, tumoral volume, prostate weight, pathological stage, prostate Gleason score, prostate primary Gleason grade, prostate secondary Gleason grade, perineural invasion, linfovascular invasion, multicentricity, oncologic surgical margins, glandular surgical margins and lymph node involvement. Our nomograme has been compared with Stephenson-Kattan nomograme using Concordane index (C index). RESULTS: The overall biochemical recurrence rate was 36.7%. The univariate study showed association with biochemical relapse of every variable analyzed except age , prostate and adenoma volume, number of prostate biopsy cores and multicentricity. Significant variables in the multivariate model included PSA (p=0.003), pathologic stage (p<0.0001), pathologic Gleason score (p<0.0001), oncologic surgical margins (p<0.0001), glandular surgical margins (p=0.005). The predictions from our nomogram appeared to be more accurate and discriminating than Stephenson-Kattan nomograme for the studied sample of patients (C index=0.757 vs 0.704). The calibration plot showed close agreement between biochemical recurrence observed and predicted probabilities. Decision curve analysis was used to select the probability cutoffs that allows to classificate patients into low, intermediate o high risk of biochemical recurrence after surgery. CONCLUSIONS: The postoperative nomogram developed can predict the probability of disease recurrence at 2, 5 and 10 years after radical prostatectomy. The nomogram may be useful in daily practice assisting the physician and the patient in deciding whether adjuvant therapy is and acceptable treatment option or if more frequent PSA controls after surgery could be done.
file://F:\RamShankar\April\04-05-12\Cip\Sour\977.html
4/7/2012