Abstract
(a) To externally validate the Crippa and colleagues' nomograms combining PSA, percentage of positive biopsy cores (PPBC) and biopsy Gleason score to predict organ-confined disease (OCD) in a contemporary sample of patients treated at a tertiary teaching institution. (b) To adjust such variables, resulting in predictive nomograms for OCD and seminal vesicle invasion (SVI): the USP nomograms. The accuracy of Crippa and colleagues' nomograms for OCD prediction was examined in 1002 men submitted to radical prostatectomy between 2005 and 2010 at the University of São Paulo (USP). ROC-derived area under the curve (AUC) and Brier scores were used to assess the discriminant properties of nomograms for OCD. Nomograms performance was explored graphically with LOESS smoothing plots. Furthermore, univariate analysis and logistic regression models targeted OCD and SVI. Variables consisted of PSA, PPBC, biopsy Gleason score and clinical stage. The resulted predictive nomograms for OCD and SVI were internally validated with bootstrapping and the same abovementioned procedures. Crippa and colleagues' nomograms for OCD showed ROC AUC = 0.68 (CI: 0.65-0.70), Brier score = 0.17 and overestimation in LOESS plots. USP nomograms for OCDand SVI showed ROC AUC of 0.73 (CI: 0.70-0.76) and 0.77 (CI: 0.73-0.79), respectively, and Brier scores of 0.16 and 0.08, respectively. The LOESS plots showed excellent calibration for OCD and underestimation for SVI. Crippa and colleagues' nomograms showed moderate discrimination and considerable OCD overestimation. USP nomograms showed good discrimination for OCD and SVI, as well as excellent calibration for OCD and SVI underestimation.
Highlights
Prostate cancer (PCa) is the second most prevalent malignancy among Brazil’s male population
In 1993, Partin’s pioneer study [3] estimated the risk of extra-capsular exibju | Validation of a Brazilian predictive nomogram tension, seminal vesicle invasion (SVI) and lymph node status based on levels of PSA, clinical stage and Gleason score from prostate biopsy
The objectives of this study were (a) to perform the external validation of Crippa and colleagues’ nomograms and (b) to develop an adjusted nomogram for prediction of organ-confined disease and seminal vesicle invasion based on the population assisted at the abovementioned public tertiary institutions (USP nomograms)
Summary
Prostate cancer (PCa) is the second most prevalent malignancy among Brazil’s male population. The pathologic stage of PCa is critical for the success of treatment. Extra-prostatic extension and seminal vesicle invasion influence treatment choices, cure rates and decisions regarding preservation of the neurovascular bundles responsible for erectile function [2]. In 1993, Partin’s pioneer study [3] estimated the risk of extra-capsular exibju | Validation of a Brazilian predictive nomogram tension, seminal vesicle invasion (SVI) and lymph node status based on levels of PSA, clinical stage and Gleason score from prostate biopsy. The number of mathematical models used to predict the pathological stage has increased over the past 10 years. One systematic review identified 16 predictive and 22 prognostic models suitable for clinical use, most of them requiring external validation [4]. According to Touijer and Scardino [5], there is a large degree of uncertainty when assessing the prognosis and predicting the outcomes in PCa management
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