Surgery confounds biology: The predictive value of stage-, grade- and prostate-specific antigen for recurrence after radical prostatectomy as a function of surgeon experience Journal Article

   


Authors: Vickers, A. J.; Savage, C. J.; Bianco, F. J.; Klein, E. A.; Kattan, M. W.; Secin, F. P.; Guillonneau, B. D.; Scardino, P. T.
Article Title: Surgery confounds biology: The predictive value of stage-, grade- and prostate-specific antigen for recurrence after radical prostatectomy as a function of surgeon experience
Abstract: Statistical models predicting cancer recurrence after surgery are based on biologic variables. We have shown previously that prostate cancer recurrence is related to both tumor biology and to surgical technique. Here, we evaluate the association between several biological predictors and biochemical recurrence across varying surgical experience. The study included two separate cohorts: 6,091 patients treated by open radical prostatectomy and an independent replication set of 2,298 patients treated laparoscopically. We calculated the odds ratios for biological predictors of biochemical recurrence-stage, Gleason grade and prostate-specific antigen (PSA)-and also the predictive accuracy (area under the curve, AUC) of a multivariable model, for subgroups of patients defined by the experience of their surgeon. In the open cohort, the odds ratio for Gleason score 8+ and advanced pathologic stage, though not PSA or Gleason score 7, increased dramatically when patients treated by surgeons with lower levels of experience were excluded (Gleason 8+: odds ratios 5.6 overall vs. 13.0 for patients treated by surgeons with 1,000+ prior cases; locally advanced disease: odds ratios of 6.6 vs. 12.2, respectively). The AUC of the multivariable model was 0.750 for patients treated by surgeons with 50 or fewer cases compared to 0.849 for patients treated by surgeons with 500 or more. Although predictiveness was lower overall for the independent replication set cohort, the main findings were replicated. Surgery confounds biology. Although our findings have no direct clinical implications, studies investigating biological variables as predictors of outcome after curative resection of cancer should consider the impact of surgeon-specific factors. Copyright © 2010 UICC.
Keywords: prediction; prostate cancer; surgeon; molecular markers; outcome studies
Journal Title: International Journal of Cancer
Volume: 128
Issue: 7
ISSN: 0020-7136
Publisher: John Wiley & Sons  
Date Published: 2011-04-01
Start Page: 1697
End Page: 1702
Language: English
DOI: 10.1002/ijc.25502
PROVIDER: scopus
PMCID: PMC2970654
PUBMED: 20533547
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-79551501126&partnerID=40&md5=96bed6519d90b18ba046ec06eb7ba18a
Notes: --- - "Export Date: 4 March 2011" - "CODEN: IJCNA" - "Source: Scopus"
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MSK Authors
  1. Caroline Savage
    80 Savage
  2. Peter T Scardino
    671 Scardino
  3. Bertrand Guillonneau
    137 Guillonneau
  4. Andrew J Vickers
    886 Vickers
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