Key result
The NCCN-g and AUA-g risk stratification systems demonstrated better discrimination ability for 8-year prostate cancer-specific mortality (AUC 0.818 and 0.793) compared to the EAU-g system (AUC 0.689).
Why the study?
It was not known which risk stratification system has the best discrimination ability for predicting prostate cancer death.
Do the NCCN-g and AUA-g risk stratification systems improve discrimination of prostate cancer-specific mortality compared to the EAU-g system in patients with non-metastatic primary prostate adenocarcinoma?
Cohort (n=310,062)
Yes
Do the NCCN-g and AUA-g risk stratification systems improve discrimination of prostate cancer-specific mortality compared to the EAU-g system in patients with non-metastatic primary prostate adenocarcinoma?
The NCCN and AUA risk stratification systems demonstrate superior discrimination for prostate cancer-specific mortality compared to the EAU system across diverse patient subgroups.
May support NCCN-g or AUA-g over EAU-g for mortality risk stratification in prostate cancer; leaves open prospective validation before practice change.
BACKGROUND: It is not known which risk stratification system has the best discrimination ability for predicting prostate cancer death. METHODS: We identified patients with non-metastatic primary prostate adenocarcinoma diagnosis between 2004 and 2015 using the Surveillance, Epidemiology, and End Results database. Patients were categorized in different risk groups using the three frequently used risk stratification systems of the National Comprehensive Cancer Network guideline (NCCN-g), American Urological Association guideline (AUA-g), and European Association of Urology guideline (EAU-g), respectively. Associations between risk classification and prostate cancer-specific mortality (PCSM) were determined using Kaplan-Meier analyses and multivariable regression with Cox proportional hazards model. Area under the receiver operating characteristics curve (AUC) analyses were used to test the discrimination ability of the three risk grouping systems. RESULTS: We analyzed 310,062 patients with a median follow-up of 61 months. A total of 36,368 deaths occurred, including 6,033 prostate cancer deaths. For all the three risk stratification systems, the risk groups were significantly associated with PCSM. The AUC of the model relying on NCCN-g, AUA-g, and EAU-g risk stratification systems for PCSM at specifically 8 years were 0.818, 0.793, and 0.689 in the entire population; 0.819, 0.795, and 0.691 in Whites; 0.802, 0.777, and 0.681 in Blacks; 0.862, 0.818, and 0.714 in Asians; 0.845, 0.806, and 0.728 in Chinese patients. Regardless of the age, marital status, socioeconomic status, and treatment modality, AUC of the model relying on NCCN-g and AUA-g for PCSM was greater than that relying on EAU-g; AUC of the model relying on NCCN-g system was greater than that of the AUA-g system. CONCLUSIONS: The NCCN-g and AUA-g risk stratification systems perform better in discriminating PCSM compared to the EAU-g system. The discrimination ability of the NCCN-g system was better than that of the AUA-g system. It is recommended to use NCCN-g to evaluate risk groups for prostate cancer patients and then provide more appropriate corresponding treatment recommendations.
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Xie et al. (2021) conducted a cohort in Non-metastatic primary prostate adenocarcinoma (n=310,062). NCCN-g and AUA-g risk stratification systems vs. EAU-g risk stratification system was evaluated on Discrimination ability (AUC) for prostate cancer-specific mortality at 8 years. The NCCN-g and AUA-g risk stratification systems demonstrated better discrimination ability for 8-year prostate cancer-specific mortality (AUC 0.818 and 0.793) compared to the EAU-g system (AUC 0.689).
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