A proposal of a new nomogram for predicting upstaging in contemporary D’Amico low-risk prostate cancer patients
Tóm tắt
Unfavorable prostate cancer (PCa) disease at final pathology affects at least 10 % of D’Amico low-risk patients. Thus, conservative therapies including active surveillance may be wrongfully applied. The purposes were to assess the rate of upstaging in a contemporary cohort of D’Amico low-risk PCa patients and to develop and externally validate a nomogram as upstaging prediction tool in two European cohorts. Analyses were restricted to 2007 patients who harbored low-risk PCa at ≥10-cores initial biopsy according to D’Amico classification (PSA <10.0 ng/ml, Gleason score <7 and clinical stage ≤T2a). Patients underwent radical prostatectomy at a high-volume center in Hamburg, Germany, from 2010 to 2015. The Hamburg cohort was randomly divided into development (n = 1338) and validation cohorts (n = 669). The development cohort was used to devise a nomogram predicting upstaging, defined as presence of ≥pT3 and/or lymph node invasion. The nomogram was externally validated in two European validation cohorts (Hamburg, n = 669; Milan, n = 465). Upstaging was observed in 187/1338 (14.0 %) of low-risk patients. In multivariable models, four of ten tested variables achieved independent predictor status: age (OR 1.07, 95 % CI 1.04–1.09), PSA (OR 1.21, 95 % CI 1.12–1.31), prostate volume (OR 0.97, 95 % CI 0.96–0.98) and percentage of positive cores (OR 1.02, 95 % CI 1.01–1.03). In external validation, the nomogram demonstrated 70.8 % (Hamburg) and 70.0 % (Milan) accuracy, respectively, with excellent concordance between predicted and observed values. Our proposed nomogram is capable to accurately identify D’Amico low-risk patients at risk of upstaging, utilizing four routinely available clinical variables, age, PSA, prostate volume and percentage of positive biopsy cores. Unfavorable prostate cancer disease at final pathology affects at least 10 % of D’Amico low-risk patients. Thus, we developed and externally validated a new nomogram based on contemporary low-risk prostate cancer patients to accurately identify D’Amico low-risk patients at risk of upstaging. It utilizes four routine variables, age, PSA, prostate volume and percentage of positive biopsy cores.
Tài liệu tham khảo
Dinh KT, Mahal BA, Ziehr DR, Muralidhar V, Chen YW, Viswanathan VB, Nezolosky MD, Beard CJ, Choueiri TK, Martin NE, Orio PF, Sweeney CJ, Trinh QD, Nguyen PL (2015) Incidence and predictors of upgrading and up staging among 10,000 contemporary patients with low risk prostate cancer. J Urol 194(2):343–349. doi:10.1016/j.juro.2015.02.015
Schiffmann J, Wenzel P, Salomon G, Budaus L, Schlomm T, Minner S, Wittmer C, Kraft S, Krech T, Steurer S, Sauter G, Beyer B, Boehm K, Tilki D, Michl U, Huland H, Graefen M, Karakiewicz PI (2015) Heterogeneity in DAmico classification-based low-risk prostate cancer: differences in upgrading and upstaging according to active surveillance eligibility. Urol Oncol 33(7):329 e13–329 e19. doi:10.1016/j.urolonc.2015.04.004
Jalloh M, Myers F, Cowan JE, Carroll PR, Cooperberg MR (2015) Racial variation in prostate cancer upgrading and upstaging among men with low-risk clinical characteristics. Eur Urol 67(3):451–457. doi:10.1016/j.eururo.2014.03.026
Gandaglia G, Ploussard G, Isbarn H, Suardi N, De Visschere PJ, Futterer JJ, Ghadjar P, Massard C, Ost P, Sooriakumaran P, Surcel CI, van der Bergh RC, Montorsi F, Ficarra V, Giannarini G, Briganti A (2015) What is the optimal definition of misclassification in patients with very low-risk prostate cancer eligible for active surveillance? Results from a multi-institutional series. Urol Oncol 33(4):164 e1–164 e9. doi:10.1016/j.urolonc.2014.12.011
Wang SY, Cowan JE, Cary KC, Chan JM, Carroll PR, Cooperberg MR (2014) Limited ability of existing nomograms to predict outcomes in men undergoing active surveillance for prostate cancer. BJU Int 114(6b):E18–E24
Eifler JB, Feng Z, Lin BM, Partin MT, Humphreys EB, Han M, Epstein JI, Walsh PC, Trock BJ, Partin AW (2013) An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int 111(1):22–29
Budaus L, Isbarn H, Schlomm T, Heinzer H, Haese A, Steuber T, Salomon G, Huland H, Graefen M (2009) Current technique of open intrafascial nerve-sparing retropubic prostatectomy. Eur Urol 56(2):317–324. doi:10.1016/j.eururo.2009.05.044
McNeal JE, Redwine EA, Freiha FS, Stamey TA (1988) Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread. Am J Surg Pathol 12(12):897–906
D’Amico AV (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280(11):969. doi:10.1001/jama.280.11.969
Posada D, Buckley TR (2004) Model selection and model averaging in phylogenetics: advantages of akaike information criterion and bayesian approaches over likelihood ratio tests. Syst Biol 53(5):793–808. doi:10.1080/10635150490522304
Cooperberg MR, Freedland SJ, Pasta DJ, Elkin EP, Presti JC Jr, Amling CL, Terris MK, Aronson WJ, Kane CJ, Carroll PR (2006) Multiinstitutional validation of the UCSF cancer of the prostate risk assessment for prediction of recurrence after radical prostatectomy. Cancer 107(10):2384–2391. doi:10.1002/cncr.22262
Tilki D, Schlenker B, John M, Buchner A, Stanislaus P, Gratzke C, Karl A, Tan GY, Ergun S, Tewari AK, Stief CG, Seitz M, Reich O (2011) Clinical and pathologic predictors of Gleason sum upgrading in patients after radical prostatectomy: results from a single institution series. Urol Oncol 29(5):508–514. doi:10.1016/j.urolonc.2009.07.003
Koh H, Kattan MW, Scardino PT, Suyama K, Maru N, Slawin K, Wheeler TM, Ohori M (2003) A nomogram to predict seminal vesicle invasion by the extent and location of cancer in systematic biopsy results. J Urol 170(4):1203–1208. doi:10.1097/01.ju.0000085074.62960.7b
Carlsson S, Maschino A, Schroder F, Bangma C, Steyerberg EW, van der Kwast T, van Leenders G, Vickers A, Lilja H, Roobol MJ (2013) Predictive value of four kallikrein markers for pathologically insignificant compared with aggressive prostate cancer in radical prostatectomy specimens: results from the European randomized study of screening for prostate cancer section Rotterdam. Eur Urol 64(5):693–699. doi:10.1016/j.eururo.2013.04.040
Ploussard G, Durand X, Xylinas E, Moutereau S, Radulescu C, Forgue A, Nicolaiew N, Terry S, Allory Y, Loric S, Salomon L, Vacherot F, de la Taille A (2011) Prostate cancer antigen 3 score accurately predicts tumour volume and might help in selecting prostate cancer patients for active surveillance. Eur Urol 59(3):422–429. doi:10.1016/j.eururo.2010.11.044
Hessels D, van Gils MPMQ, van Hooij O, Jannink SA, Witjes JA, Verhaegh GW, Schalken JA (2010) Predictive value of PCA3 in urinary sediments in determining clinico-pathological characteristics of prostate cancer. Prostate 70(1):10–16. doi:10.1002/pros.21032
Liss MA, Santos R, Osann K, Lau A, Ahlering TE, Ornstein DK (2010) PCA3 molecular urine assay for prostate cancer: association with pathologic features and impact of collection protocols. World J Urol 29(5):683–688. doi:10.1007/s00345-010-0623-6
Klein EA, Cooperberg MR, Magi-Galluzzi C, Simko JP, Falzarano SM, Maddala T, Chan JM, Li J, Cowan JE, Tsiatis AC, Cherbavaz DB, Pelham RJ, Tenggara-Hunter I, Baehner FL, Knezevic D, Febbo PG, Shak S, Kattan MW, Lee M, Carroll PR (2014) A 17-gene assay to predict prostate cancer aggressiveness in the context of Gleason grade heterogeneity, tumor multifocality, and biopsy undersampling. Eur Urol 66(3):550–560. doi:10.1016/j.eururo.2014.05.004
Feng TS, Sharif-Afshar AR, Wu J, Li Q, Luthringer D, Saouaf R, Kim HL (2015) Multiparametric MRI improves accuracy of clinical nomograms for predicting extracapsular extension of prostate cancer. Urology 86(2):332–337. doi:10.1016/j.urology.2015.06.003
Walton Diaz A, Shakir NA, George AK, Rais-Bahrami S, Turkbey B, Rothwax JT, Stamatakis L, Hong CW, Siddiqui MM, Okoro C, Raskolnikov D, Su D, Shih J, Han H, Parnes HL, Merino MJ, Simon RM, Wood BJ, Choyke PL, Pinto PA (2015) Use of serial multiparametric magnetic resonance imaging in the management of patients with prostate cancer on active surveillance. Urol Oncol 33(5):202 e1–202 e7. doi:10.1016/j.urolonc.2015.01.023
Futterer JJ, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A, Taneja SS, Thoeny H, Villeirs G, Villers A (2015) Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol. doi:10.1016/j.eururo.2015.01.013
Schoots IG, Petrides N, Giganti F, Bokhorst LP, Rannikko A, Klotz L, Villers A, Hugosson J, Moore CM (2015) Magnetic resonance imaging in active surveillance of prostate cancer: a systematic review. Eur Urol 67(4):627–636. doi:10.1016/j.eururo.2014.10.050
Barentsz JO, Weinreb JC, Verma S, Thoeny HC, Tempany CM, Shtern F, Padhani AR, Margolis D, Macura KJ, Haider MA, Cornud F, Choyke PL (2016) Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imaging and recommendations for use. Eur Urol 69(1):41–49. doi:10.1016/j.eururo.2015.08.038
Siddiqui MM, Truong H, Rais-Bahrami S, Stamatakis L, Logan J, Walton-Diaz A, Turkbey B, Choyke PL, Wood BJ, Simon RM, Pinto PA (2015) Clinical implications of a multiparametric magnetic resonance imaging based nomogram applied to prostate cancer active surveillance. J Urol 193(6):1943–1949. doi:10.1016/j.juro.2015.01.088
Baco E, Rud E, Vlatkovic L, Svindland A, Eggesbo HB, Hung AJ, Matsugasumi T, Bernhard JC, Gill IS, Ukimura O (2015) Predictive value of magnetic resonance imaging determined tumor contact length for extracapsular extension of prostate cancer. J Urol 193(2):466–472. doi:10.1016/j.juro.2014.08.084