Multi-institutional validation of the CAPRA-S score to predict disease recurrence and mortality after radical prostatectomy

Sanoj Punnen, Stephen J. Freedland, Joseph C. Presti, William J. Aronson, Martha Kennedy Terris, Christopher J. Kane, Christopher L. Amling, Peter R. Carroll, Matthew R. Cooperberg

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Background The University of California, San Francisco, Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score uses pathologic data from radical prostatectomy (RP) to predict prostate cancer recurrence and mortality. However, this clinical tool has never been validated externally. Objective To validate CAPRA-S in a large, multi-institutional, external database. Design, setting, and participants The Shared Equal Access Regional Cancer Hospital (SEARCH) database consists of 2892 men who underwent RP from 2001 to 2011. With a median follow-up of 58 mo, 2670 men (92%) had complete data to calculate a CAPRA-S score. Intervention RP. Outcome measurements and statistical analysis The main outcome was biochemical recurrence. Performance of CAPRA-S in detecting recurrence was assessed and compared with a validated postoperative nomogram by concordance index (c-index), calibration plots, and decision curve analysis. Prediction of cancer-specific mortality was assessed by Kaplan-Meier analysis and the c-index. Results and limitations The mean age was 62 yr (standard deviation: 6.3), and 34.3% of men had recurrence. The 5-yr progression-free probability for those patients with a CAPRA-S score of 0-2, 3-5, and 6-10 (defining low, intermediate, and high risk) was 72%, 39%, and 17%, respectively. The CAPRA-S c-index was 0.73 in this validation set, compared with a c-index of 0.72 for the Stephenson nomogram. Although CAPRA-S was optimistic in predicting the likelihood of being free of recurrence at 5 yr, it outperformed the Stephenson nomogram on both calibration plots and decision curve analysis. The c-index for predicting cancer-specific mortality was 0.85, with the caveat that this number is based on only 61 events. Conclusions In this external validation, the CAPRA-S score predicted recurrence and mortality after RP with a c-index >0.70. The score is an effective prognostic tool that may aid in determining the need for adjuvant therapy.

Original languageEnglish (US)
Pages (from-to)1171-1177
Number of pages7
JournalEuropean urology
Volume65
Issue number6
DOIs
StatePublished - Jan 1 2014

Fingerprint

Prostatectomy
Prostatic Neoplasms
Recurrence
Mortality
Nomograms
Decision Support Techniques
Calibration
Databases
Cancer Care Facilities
San Francisco
Kaplan-Meier Estimate
Neoplasms

Keywords

  • Nomogram
  • Outcomes
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Multi-institutional validation of the CAPRA-S score to predict disease recurrence and mortality after radical prostatectomy. / Punnen, Sanoj; Freedland, Stephen J.; Presti, Joseph C.; Aronson, William J.; Terris, Martha Kennedy; Kane, Christopher J.; Amling, Christopher L.; Carroll, Peter R.; Cooperberg, Matthew R.

In: European urology, Vol. 65, No. 6, 01.01.2014, p. 1171-1177.

Research output: Contribution to journalArticle

Punnen, S, Freedland, SJ, Presti, JC, Aronson, WJ, Terris, MK, Kane, CJ, Amling, CL, Carroll, PR & Cooperberg, MR 2014, 'Multi-institutional validation of the CAPRA-S score to predict disease recurrence and mortality after radical prostatectomy', European urology, vol. 65, no. 6, pp. 1171-1177. https://doi.org/10.1016/j.eururo.2013.03.058
Punnen, Sanoj ; Freedland, Stephen J. ; Presti, Joseph C. ; Aronson, William J. ; Terris, Martha Kennedy ; Kane, Christopher J. ; Amling, Christopher L. ; Carroll, Peter R. ; Cooperberg, Matthew R. / Multi-institutional validation of the CAPRA-S score to predict disease recurrence and mortality after radical prostatectomy. In: European urology. 2014 ; Vol. 65, No. 6. pp. 1171-1177.
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abstract = "Background The University of California, San Francisco, Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score uses pathologic data from radical prostatectomy (RP) to predict prostate cancer recurrence and mortality. However, this clinical tool has never been validated externally. Objective To validate CAPRA-S in a large, multi-institutional, external database. Design, setting, and participants The Shared Equal Access Regional Cancer Hospital (SEARCH) database consists of 2892 men who underwent RP from 2001 to 2011. With a median follow-up of 58 mo, 2670 men (92{\%}) had complete data to calculate a CAPRA-S score. Intervention RP. Outcome measurements and statistical analysis The main outcome was biochemical recurrence. Performance of CAPRA-S in detecting recurrence was assessed and compared with a validated postoperative nomogram by concordance index (c-index), calibration plots, and decision curve analysis. Prediction of cancer-specific mortality was assessed by Kaplan-Meier analysis and the c-index. Results and limitations The mean age was 62 yr (standard deviation: 6.3), and 34.3{\%} of men had recurrence. The 5-yr progression-free probability for those patients with a CAPRA-S score of 0-2, 3-5, and 6-10 (defining low, intermediate, and high risk) was 72{\%}, 39{\%}, and 17{\%}, respectively. The CAPRA-S c-index was 0.73 in this validation set, compared with a c-index of 0.72 for the Stephenson nomogram. Although CAPRA-S was optimistic in predicting the likelihood of being free of recurrence at 5 yr, it outperformed the Stephenson nomogram on both calibration plots and decision curve analysis. The c-index for predicting cancer-specific mortality was 0.85, with the caveat that this number is based on only 61 events. Conclusions In this external validation, the CAPRA-S score predicted recurrence and mortality after RP with a c-index >0.70. The score is an effective prognostic tool that may aid in determining the need for adjuvant therapy.",
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T1 - Multi-institutional validation of the CAPRA-S score to predict disease recurrence and mortality after radical prostatectomy

AU - Punnen, Sanoj

AU - Freedland, Stephen J.

AU - Presti, Joseph C.

AU - Aronson, William J.

AU - Terris, Martha Kennedy

AU - Kane, Christopher J.

AU - Amling, Christopher L.

AU - Carroll, Peter R.

AU - Cooperberg, Matthew R.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background The University of California, San Francisco, Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score uses pathologic data from radical prostatectomy (RP) to predict prostate cancer recurrence and mortality. However, this clinical tool has never been validated externally. Objective To validate CAPRA-S in a large, multi-institutional, external database. Design, setting, and participants The Shared Equal Access Regional Cancer Hospital (SEARCH) database consists of 2892 men who underwent RP from 2001 to 2011. With a median follow-up of 58 mo, 2670 men (92%) had complete data to calculate a CAPRA-S score. Intervention RP. Outcome measurements and statistical analysis The main outcome was biochemical recurrence. Performance of CAPRA-S in detecting recurrence was assessed and compared with a validated postoperative nomogram by concordance index (c-index), calibration plots, and decision curve analysis. Prediction of cancer-specific mortality was assessed by Kaplan-Meier analysis and the c-index. Results and limitations The mean age was 62 yr (standard deviation: 6.3), and 34.3% of men had recurrence. The 5-yr progression-free probability for those patients with a CAPRA-S score of 0-2, 3-5, and 6-10 (defining low, intermediate, and high risk) was 72%, 39%, and 17%, respectively. The CAPRA-S c-index was 0.73 in this validation set, compared with a c-index of 0.72 for the Stephenson nomogram. Although CAPRA-S was optimistic in predicting the likelihood of being free of recurrence at 5 yr, it outperformed the Stephenson nomogram on both calibration plots and decision curve analysis. The c-index for predicting cancer-specific mortality was 0.85, with the caveat that this number is based on only 61 events. Conclusions In this external validation, the CAPRA-S score predicted recurrence and mortality after RP with a c-index >0.70. The score is an effective prognostic tool that may aid in determining the need for adjuvant therapy.

AB - Background The University of California, San Francisco, Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score uses pathologic data from radical prostatectomy (RP) to predict prostate cancer recurrence and mortality. However, this clinical tool has never been validated externally. Objective To validate CAPRA-S in a large, multi-institutional, external database. Design, setting, and participants The Shared Equal Access Regional Cancer Hospital (SEARCH) database consists of 2892 men who underwent RP from 2001 to 2011. With a median follow-up of 58 mo, 2670 men (92%) had complete data to calculate a CAPRA-S score. Intervention RP. Outcome measurements and statistical analysis The main outcome was biochemical recurrence. Performance of CAPRA-S in detecting recurrence was assessed and compared with a validated postoperative nomogram by concordance index (c-index), calibration plots, and decision curve analysis. Prediction of cancer-specific mortality was assessed by Kaplan-Meier analysis and the c-index. Results and limitations The mean age was 62 yr (standard deviation: 6.3), and 34.3% of men had recurrence. The 5-yr progression-free probability for those patients with a CAPRA-S score of 0-2, 3-5, and 6-10 (defining low, intermediate, and high risk) was 72%, 39%, and 17%, respectively. The CAPRA-S c-index was 0.73 in this validation set, compared with a c-index of 0.72 for the Stephenson nomogram. Although CAPRA-S was optimistic in predicting the likelihood of being free of recurrence at 5 yr, it outperformed the Stephenson nomogram on both calibration plots and decision curve analysis. The c-index for predicting cancer-specific mortality was 0.85, with the caveat that this number is based on only 61 events. Conclusions In this external validation, the CAPRA-S score predicted recurrence and mortality after RP with a c-index >0.70. The score is an effective prognostic tool that may aid in determining the need for adjuvant therapy.

KW - Nomogram

KW - Outcomes

KW - Prostate cancer

KW - Radical prostatectomy

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