Re-calibration and external validation of an existing nomogram to predict aggressive recurrences after radical prostatectomy

Florian R. Schroeck, Michael W. Kattan, Judd W. Moul, William J. Aronson, Joseph C. Presti, Martha Kennedy Terris, Christopher J. Kane, Christopher L. Amling, Leon Sun, Stephen J. Freedland

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Study Type - Prognosis (case series) Level of Evidence 4 Objective to re-calibrate the previously published Duke Prostate Center (DPC) nomogram for the prediction of biochemical recurrence (BCR) after radical prostatectomy (RP) to not only predict overall BCR but also the clinically more relevant endpoint of an aggressive recurrence (i.e. a BCR with a postoperative PSA doubling time (PSADT) of <9 months). Patients and Methods Using the established point-scale system based upon the previously published DPC nomogram, we re-calibrated this point system to predict not just BCR, but also aggressive BCR within 2599 men treated with RP from the DPC database. PSADT was computed on all patients meeting the recurrence definition who had a minimum of two PSA values, separated by at least 3 months, and ≤2 years after recurrence. External validation was performed using data from 1695 men treated with RP within the Shared Equal Access Regional Cancer Hospital (SEARCH) database by calculating the concordance index c and by plotting calibration curves. Results The median follow-up for patients with no BCR was 56 and 47 months for DPC and SEARCH, respectively. In the DPC modelling cohort and the SEARCH validation cohort, 645 (25%) and 557 (33%) men had BCR, while 83 (3.2%) and 71 (4.2%) patients had an aggressive recurrence. In external validation, predictive accuracy for an aggressive BCR was high (c = 0.83) and the nomogram showed good calibration. Conclusions We re-calibrated an existing nomogram to not only predict overall BCR after RP but also aggressive recurrence after RP. Our new tool can provide valuable information for patient counselling and patient selection for adjuvant therapy trials.

Original languageEnglish (US)
Pages (from-to)1654-1659
Number of pages6
JournalBJU International
Volume105
Issue number12
DOIs
StatePublished - Jun 1 2010

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Nomograms
Prostatectomy
Calibration
Recurrence
Prostate
Cancer Care Facilities
Databases
Patient Selection

Keywords

  • Aggressive recurrence
  • Biochemical recurrence
  • Nomogram
  • PSA doubling time
  • Prostate cancer

ASJC Scopus subject areas

  • Urology

Cite this

Re-calibration and external validation of an existing nomogram to predict aggressive recurrences after radical prostatectomy. / Schroeck, Florian R.; Kattan, Michael W.; Moul, Judd W.; Aronson, William J.; Presti, Joseph C.; Terris, Martha Kennedy; Kane, Christopher J.; Amling, Christopher L.; Sun, Leon; Freedland, Stephen J.

In: BJU International, Vol. 105, No. 12, 01.06.2010, p. 1654-1659.

Research output: Contribution to journalArticle

Schroeck, FR, Kattan, MW, Moul, JW, Aronson, WJ, Presti, JC, Terris, MK, Kane, CJ, Amling, CL, Sun, L & Freedland, SJ 2010, 'Re-calibration and external validation of an existing nomogram to predict aggressive recurrences after radical prostatectomy', BJU International, vol. 105, no. 12, pp. 1654-1659. https://doi.org/10.1111/j.1464-410X.2009.09060.x
Schroeck, Florian R. ; Kattan, Michael W. ; Moul, Judd W. ; Aronson, William J. ; Presti, Joseph C. ; Terris, Martha Kennedy ; Kane, Christopher J. ; Amling, Christopher L. ; Sun, Leon ; Freedland, Stephen J. / Re-calibration and external validation of an existing nomogram to predict aggressive recurrences after radical prostatectomy. In: BJU International. 2010 ; Vol. 105, No. 12. pp. 1654-1659.
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abstract = "Study Type - Prognosis (case series) Level of Evidence 4 Objective to re-calibrate the previously published Duke Prostate Center (DPC) nomogram for the prediction of biochemical recurrence (BCR) after radical prostatectomy (RP) to not only predict overall BCR but also the clinically more relevant endpoint of an aggressive recurrence (i.e. a BCR with a postoperative PSA doubling time (PSADT) of <9 months). Patients and Methods Using the established point-scale system based upon the previously published DPC nomogram, we re-calibrated this point system to predict not just BCR, but also aggressive BCR within 2599 men treated with RP from the DPC database. PSADT was computed on all patients meeting the recurrence definition who had a minimum of two PSA values, separated by at least 3 months, and ≤2 years after recurrence. External validation was performed using data from 1695 men treated with RP within the Shared Equal Access Regional Cancer Hospital (SEARCH) database by calculating the concordance index c and by plotting calibration curves. Results The median follow-up for patients with no BCR was 56 and 47 months for DPC and SEARCH, respectively. In the DPC modelling cohort and the SEARCH validation cohort, 645 (25{\%}) and 557 (33{\%}) men had BCR, while 83 (3.2{\%}) and 71 (4.2{\%}) patients had an aggressive recurrence. In external validation, predictive accuracy for an aggressive BCR was high (c = 0.83) and the nomogram showed good calibration. Conclusions We re-calibrated an existing nomogram to not only predict overall BCR after RP but also aggressive recurrence after RP. Our new tool can provide valuable information for patient counselling and patient selection for adjuvant therapy trials.",
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T1 - Re-calibration and external validation of an existing nomogram to predict aggressive recurrences after radical prostatectomy

AU - Schroeck, Florian R.

AU - Kattan, Michael W.

AU - Moul, Judd W.

AU - Aronson, William J.

AU - Presti, Joseph C.

AU - Terris, Martha Kennedy

AU - Kane, Christopher J.

AU - Amling, Christopher L.

AU - Sun, Leon

AU - Freedland, Stephen J.

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Y1 - 2010/6/1

N2 - Study Type - Prognosis (case series) Level of Evidence 4 Objective to re-calibrate the previously published Duke Prostate Center (DPC) nomogram for the prediction of biochemical recurrence (BCR) after radical prostatectomy (RP) to not only predict overall BCR but also the clinically more relevant endpoint of an aggressive recurrence (i.e. a BCR with a postoperative PSA doubling time (PSADT) of <9 months). Patients and Methods Using the established point-scale system based upon the previously published DPC nomogram, we re-calibrated this point system to predict not just BCR, but also aggressive BCR within 2599 men treated with RP from the DPC database. PSADT was computed on all patients meeting the recurrence definition who had a minimum of two PSA values, separated by at least 3 months, and ≤2 years after recurrence. External validation was performed using data from 1695 men treated with RP within the Shared Equal Access Regional Cancer Hospital (SEARCH) database by calculating the concordance index c and by plotting calibration curves. Results The median follow-up for patients with no BCR was 56 and 47 months for DPC and SEARCH, respectively. In the DPC modelling cohort and the SEARCH validation cohort, 645 (25%) and 557 (33%) men had BCR, while 83 (3.2%) and 71 (4.2%) patients had an aggressive recurrence. In external validation, predictive accuracy for an aggressive BCR was high (c = 0.83) and the nomogram showed good calibration. Conclusions We re-calibrated an existing nomogram to not only predict overall BCR after RP but also aggressive recurrence after RP. Our new tool can provide valuable information for patient counselling and patient selection for adjuvant therapy trials.

AB - Study Type - Prognosis (case series) Level of Evidence 4 Objective to re-calibrate the previously published Duke Prostate Center (DPC) nomogram for the prediction of biochemical recurrence (BCR) after radical prostatectomy (RP) to not only predict overall BCR but also the clinically more relevant endpoint of an aggressive recurrence (i.e. a BCR with a postoperative PSA doubling time (PSADT) of <9 months). Patients and Methods Using the established point-scale system based upon the previously published DPC nomogram, we re-calibrated this point system to predict not just BCR, but also aggressive BCR within 2599 men treated with RP from the DPC database. PSADT was computed on all patients meeting the recurrence definition who had a minimum of two PSA values, separated by at least 3 months, and ≤2 years after recurrence. External validation was performed using data from 1695 men treated with RP within the Shared Equal Access Regional Cancer Hospital (SEARCH) database by calculating the concordance index c and by plotting calibration curves. Results The median follow-up for patients with no BCR was 56 and 47 months for DPC and SEARCH, respectively. In the DPC modelling cohort and the SEARCH validation cohort, 645 (25%) and 557 (33%) men had BCR, while 83 (3.2%) and 71 (4.2%) patients had an aggressive recurrence. In external validation, predictive accuracy for an aggressive BCR was high (c = 0.83) and the nomogram showed good calibration. Conclusions We re-calibrated an existing nomogram to not only predict overall BCR after RP but also aggressive recurrence after RP. Our new tool can provide valuable information for patient counselling and patient selection for adjuvant therapy trials.

KW - Aggressive recurrence

KW - Biochemical recurrence

KW - Nomogram

KW - PSA doubling time

KW - Prostate cancer

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