To develop and externally validate a novel nomogram aimed at predicting cancer-specific mortality (CSM) after biochemical recurrence (BCR) among prostate cancer (PCa) patients treated with radical prostatectomy (RP) with or without adjuvant external beam radiotherapy (aRT) and/or hormonal therapy (aHT).
The development cohort included 689 consecutive PCa patients treated with RP between 1987 and 2011 with subsequent BCR, defined as two subsequent prostate-specific antigen values >0. 2 ng/ml. Multivariable competing-risks regression analyses tested the predictors of CSM after BCR for the purpose of 5-year CSM nomogram development. Validation (2000 bootstrap resamples) was internally tested. External validation was performed into a population of 6734 PCa patients with BCR after treatment with RP at the Mayo Clinic from 1987 to 2011. The predictive accuracy (PA) was quantified using the receiver operating characteristic-derived area under the curve and the calibration plot method.
The 5-year CSM-free survival rate was 83. 6% (confidence interval [CI]: 79. 6-87. 2). In multivariable analyses, pathologic stage T3b or more (hazard ratio [HR]: 7. 42; p = 0. 008), pathologic Gleason score 8-10 (HR: 2. 19; p = 0. 003), lymph node invasion (HR: 3. 57; p = 0. 001), time to BCR (HR: 0. 99; p = 0. 03) and age at BCR (HR: 1. 04; p = 0. 04), were each significantly associated with the risk of CSM after BCR. The bootstrap-corrected PA was 87. 4% (bootstrap 95% CI: 82. 0-91. 7%). External validation of our nomogram showed a good PA at 83. 2%.
We developed and externally validated the first nomogram predicting 5-year CSM applicable to contemporary patients with BCR after RP with or without adjuvant treatment.
European journal of cancer (Oxford, England : 1990). 2015 Dec 18 [Epub ahead of print]
Paolo Dell'Oglio, Nazareno Suardi, Stephen A Boorjian, Nicola Fossati, Giorgio Gandaglia, Zhe Tian, Marco Moschini, Umberto Capitanio, Pierre I Karakiewicz, Francesco Montorsi, R Jeffrey Karnes, Alberto Briganti
Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada. Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. , Department of Urology, Mayo Clinic, Rochester, MN, USA. , Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. , Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. , Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada. , Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Mayo Clinic, Rochester, MN, USA. , Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. , Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada. , Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. , Department of Urology, Mayo Clinic, Rochester, MN, USA. , Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.