Stratification of high-risk prostate cancer into prognostic categories: a European multi-institutional study
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Stratification of high-risk prostate cancer into prognostic categories: a European multi-institutional study. / Joniau, Steven; Briganti, Alberto; Gontero, Paolo; Gandaglia, Giorgio; Tosco, Lorenzo; Fieuws, Steffen; Tombal, Bertrand; Marchioro, Giansilvio; Walz, Jochen; Kneitz, Burkhard; Bader, Pia; Frohneberg, Detlef; Tizzani, Alessandro; Graefen, Markus; van Cangh, Paul; Karnes, R Jeffrey; Montorsi, Francesco; Van Poppel, Hein; Spahn, Martin; European Multicenter Prostate Cancer Clinical and Translational Research group (EMPaCT).
in: EUR UROL, Jahrgang 67, Nr. 1, 01.01.2015, S. 157-64.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Stratification of high-risk prostate cancer into prognostic categories: a European multi-institutional study
AU - Joniau, Steven
AU - Briganti, Alberto
AU - Gontero, Paolo
AU - Gandaglia, Giorgio
AU - Tosco, Lorenzo
AU - Fieuws, Steffen
AU - Tombal, Bertrand
AU - Marchioro, Giansilvio
AU - Walz, Jochen
AU - Kneitz, Burkhard
AU - Bader, Pia
AU - Frohneberg, Detlef
AU - Tizzani, Alessandro
AU - Graefen, Markus
AU - van Cangh, Paul
AU - Karnes, R Jeffrey
AU - Montorsi, Francesco
AU - Van Poppel, Hein
AU - Spahn, Martin
AU - European Multicenter Prostate Cancer Clinical and Translational Research group (EMPaCT)
N1 - Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - BACKGROUND: High-risk prostate cancer (PCa) is an extremely heterogeneous disease. A clear definition of prognostic subgroups is mandatory.OBJECTIVE: To develop a pretreatment prognostic model for PCa-specific survival (PCSS) in high-risk PCa based on combinations of unfavorable risk factors.DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective multicenter cohort study including 1360 consecutive patients with high-risk PCa treated at eight European high-volume centers.INTERVENTION: Retropubic radical prostatectomy with pelvic lymphadenectomy.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Two Cox multivariable regression models were constructed to predict PCSS as a function of dichotomization of clinical stage (< cT3 vs cT3-4), Gleason score (GS) (2-7 vs 8-10), and prostate-specific antigen (PSA; ≤ 20 ng/ml vs > 20 ng/ml). The first "extended" model includes all seven possible combinations; the second "simplified" model includes three subgroups: a good prognosis subgroup (one single high-risk factor); an intermediate prognosis subgroup (PSA >20 ng/ml and stage cT3-4); and a poor prognosis subgroup (GS 8-10 in combination with at least one other high-risk factor). The predictive accuracy of the models was summarized and compared. Survival estimates and clinical and pathologic outcomes were compared between the three subgroups.RESULTS AND LIMITATIONS: The simplified model yielded an R(2) of 33% with a 5-yr area under the curve (AUC) of 0.70 with no significant loss of predictive accuracy compared with the extended model (R(2): 34%; AUC: 0.71). The 5- and 10-yr PCSS rates were 98.7% and 95.4%, 96.5% and 88.3%, 88.8% and 79.7%, for the good, intermediate, and poor prognosis subgroups, respectively (p = 0.0003). Overall survival, clinical progression-free survival, and histopathologic outcomes significantly worsened in a stepwise fashion from the good to the poor prognosis subgroups. Limitations of the study are the retrospective design and the long study period.CONCLUSIONS: This study presents an intuitive and easy-to-use stratification of high-risk PCa into three prognostic subgroups. The model is useful for counseling and decision making in the pretreatment setting.
AB - BACKGROUND: High-risk prostate cancer (PCa) is an extremely heterogeneous disease. A clear definition of prognostic subgroups is mandatory.OBJECTIVE: To develop a pretreatment prognostic model for PCa-specific survival (PCSS) in high-risk PCa based on combinations of unfavorable risk factors.DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective multicenter cohort study including 1360 consecutive patients with high-risk PCa treated at eight European high-volume centers.INTERVENTION: Retropubic radical prostatectomy with pelvic lymphadenectomy.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Two Cox multivariable regression models were constructed to predict PCSS as a function of dichotomization of clinical stage (< cT3 vs cT3-4), Gleason score (GS) (2-7 vs 8-10), and prostate-specific antigen (PSA; ≤ 20 ng/ml vs > 20 ng/ml). The first "extended" model includes all seven possible combinations; the second "simplified" model includes three subgroups: a good prognosis subgroup (one single high-risk factor); an intermediate prognosis subgroup (PSA >20 ng/ml and stage cT3-4); and a poor prognosis subgroup (GS 8-10 in combination with at least one other high-risk factor). The predictive accuracy of the models was summarized and compared. Survival estimates and clinical and pathologic outcomes were compared between the three subgroups.RESULTS AND LIMITATIONS: The simplified model yielded an R(2) of 33% with a 5-yr area under the curve (AUC) of 0.70 with no significant loss of predictive accuracy compared with the extended model (R(2): 34%; AUC: 0.71). The 5- and 10-yr PCSS rates were 98.7% and 95.4%, 96.5% and 88.3%, 88.8% and 79.7%, for the good, intermediate, and poor prognosis subgroups, respectively (p = 0.0003). Overall survival, clinical progression-free survival, and histopathologic outcomes significantly worsened in a stepwise fashion from the good to the poor prognosis subgroups. Limitations of the study are the retrospective design and the long study period.CONCLUSIONS: This study presents an intuitive and easy-to-use stratification of high-risk PCa into three prognostic subgroups. The model is useful for counseling and decision making in the pretreatment setting.
U2 - 10.1016/j.eururo.2014.01.020
DO - 10.1016/j.eururo.2014.01.020
M3 - SCORING: Journal article
C2 - 24486307
VL - 67
SP - 157
EP - 164
JO - EUR UROL
JF - EUR UROL
SN - 0302-2838
IS - 1
ER -