Key result
Preoperative nomogram incorporating Gleason score outperforms AJCC staging in predicting cause-specific death.
Why the study?
A preoperative tool to identify locally advanced prostate cancer patients who benefit most from radical prostatectomy was needed to improve survival prediction beyond existing staging systems.
Does a preoperative nomogram improve survival prediction compared to the AJCC staging system in patients with locally advanced prostate cancer undergoing radical prostatectomy?
Cohort (n=14,185)
Yes
Does a preoperative nomogram improve survival prediction compared to the AJCC staging system in patients with locally advanced prostate cancer undergoing radical prostatectomy?
A novel preoperative nomogram incorporating N stage, Gleason score, and percent of positive cores provides better prognostic stratification than the AJCC staging system for patients with locally advanced prostate cancer.
Answers are grounded in this paper and cite their sources.
May improve preoperative stratification in locally advanced prostate cancer; leaves open need for prospective validation before changing AJCC-based decisions.
BACKGROUND: For selected locally advanced prostate cancer (PCa) patients, radical prostatectomy (RP) is one of the first-line treatments. We aimed to develop a preoperative nomogram to identify what kinds of patients can get the most survival benefits after RP. METHODS: We conducted analyses with data from the Surveillance, Epidemiology, and End Results (SEER) database. Covariates used for analyses included age at diagnosis, marital status, race, American Joint Committee on Cancer (AJCC) 7th TNM stage, Prostate specific antigen, Gleason biopsy score (GS), percent of positive cores. We estimated the cumulative incidence function for cause-specific death. The Fine and Gray's proportional subdistribution hazard approach was used to perform multivariable competing risk analyses and reveal prognostic factors. A nomogram was built by these factors (including GS, percent of positive cores and N stage) and validated by concordance index and calibration curves. Risk stratification was established based on the nomogram. RESULTS: We studied 14,185 patients. N stage, GS, and percent of positive cores were the independent prognostic factors used to construct the nomogram. For validating, in the training cohort, the C-index was 0.779 (95% CI 0.736-0.822), and in the validation cohort, the C-index was 0.773 (95% CI 0.710-0.836). Calibration curves showed that the predicted survival and actual survival were very close. The nomogram performed better over the AJCC staging system (C-index 0.779 versus 0.764 for training cohort, and 0.773 versus 0.744 for validation cohort). The new stratification of risk groups based on the nomogram also showed better discrimination than the AJCC staging system. CONCLUSIONS: The preoperative nomogram can provide favorable prognosis stratification ability to help clinicians identify patients who are suitable for surgery.
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Zhou et al. (2020) conducted a cohort in Locally advanced prostate cancer (n=14,185). Preoperative nomogram (incorporating N stage, Gleason score, and percent of positive cores) vs. AJCC staging system was evaluated on Prognostic performance for cause-specific death (Concordance index) (C-index 0.773 (validation cohort), 95% CI 0.710-0.836). A preoperative nomogram incorporating N stage, Gleason score, and percent of positive cores predicted cause-specific death better than the AJCC staging system (validation C-index 0.773 vs 0.744).
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