TY - JOUR
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 K.
AU - Kane, Christopher J.
AU - Amling, Christopher L.
AU - Carroll, Peter R.
AU - Cooperberg, Matthew R.
N1 - Funding Information:
Funding/Support and role of the sponsor: Funding for the collection and management of the data was from the US Department of Veterans Affairs, the US Department of Defense, Prostate Cancer Research Program (C.J.K., S.J.F.), NIH R01CA100938 (W.J.A.), NIH Specialized Programs of Research Excellence Grant P50 CA92131-01A1 (W.J.A.), Georgia Cancer Coalition (M.K.T.), and the American Urological Association Foundation/Astellas Rising Star in Urology Award (S.J.F.). Views and opinions of and endorsements by the authors do not reflect those of the US Army or the Department of Defense.
PY - 2014/6
Y1 - 2014/6
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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UR - http://www.scopus.com/inward/citedby.url?scp=84899520647&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2013.03.058
DO - 10.1016/j.eururo.2013.03.058
M3 - Article
C2 - 23587869
AN - SCOPUS:84899520647
SN - 0302-2838
VL - 65
SP - 1171
EP - 1177
JO - European urology
JF - European urology
IS - 6
ER -
