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Improving the stratification of intermediate risk prostate cancer.
- Source :
-
Minerva urology and nephrology [Minerva Urol Nephrol] 2022 Oct; Vol. 74 (5), pp. 590-598. Date of Electronic Publication: 2021 Apr 22. - Publication Year :
- 2022
-
Abstract
- Background: Intermediate risk prostate cancer (IR PCa) may exhibit a wide array of phenotypes, from favorable to unfavorable. NCCN criteria help distinguishing between favorable versus unfavorable subgroups. We studied and attempted to improve this classification.<br />Methods: Within the SEER database 2010-2016, we identified 19,193 IR PCa patients treated with radical prostatectomy. A multivariable logistic regression model predicting unfavorable IR PCa was developed and externally validated, in addition to a head-to-head comparison with NCCN IR PCa stratification.<br />Results: Model development (development cohort N.=13,436: 3585 unfavorable versus 9851 favorable) rested on age, PSA, clinical T stage, biopsy Gleason Grade Group (GGG) and percentage of positive cores. All were independent predictors of unfavorable IR PCa. In external validation cohort (N.=5757: 1652 unfavorable versus 4105 favorable), NCCN stratification was 61.8% accurate in discriminating between favorable versus unfavorable, compared to 67.6% for nomogram, which exhibited excellent calibration, less pronounced departures from ideal prediction and greater net-benefit in decision curve analyses (DCA) than NCCN stratification. The optimal nomogram cutoff misclassified 312 of 1976 patients (15.8%) versus 598 of 2877 (20.8%) for NCCN stratification. Of NCCN misclassified patients, 90.0% harbored pT3-4 stages versus 84.6% of nomogram.<br />Conclusions: The newly developed, externally validated nomogram discriminates better between favorable versus unfavorable IR PCa, according to overall accuracy, calibration, DCA, and actual numbers and stage distribution of misclassified patients.
Details
- Language :
- English
- ISSN :
- 2724-6442
- Volume :
- 74
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Minerva urology and nephrology
- Publication Type :
- Academic Journal
- Accession number :
- 33887893
- Full Text :
- https://doi.org/10.23736/S2724-6051.21.04314-7