International validation of a preoperative nomogram for prostate cancer recurrence after radical prostatectomy Journal Article


Authors: Graefen, M.; Karakiewicz, P. I.; Cagiannos, I.; Quinn, D. I.; Henshall, S. M.; Grygiel, J. J.; Sutherland, R. L.; Stricker, P. D.; Klein, E.; Kupelian, P.; Skinner, D. G.; Lieskovsky, G.; Bochner, B.; Huland, H.; Hammerer, P. G.; Haese, A.; Erbersdobler, A.; Eastham, J. A.; De Kernion, J.; Cangiano, T.; Schröder, F. H.; Wildhagen, M. F.; Van Der Kwast, T. H.; Scardino, P. T.; Kattan, M. W.
Article Title: International validation of a preoperative nomogram for prostate cancer recurrence after radical prostatectomy
Abstract: Purpose: We evaluated the predictive accuracy of a recently published preoperative nomogram for prostate cancer that predicts 5-year freedom from recurrence. We applied this nomogram to patients from seven different institutions spanning three continents. Methods: Clinical data of 6,754 patients were supplied for validation, and 6,232 complete records were used. Nomogram-predicted probabilities of 60-month freedom from recurrence were compared with actual follow-up in two ways. First, areas under the receiver operating characteristic curves (AUCs) were determined for the entire data set according to several variables, including the institution where treatment was delivered. Second, nomogram classification-based risk quadrants were compared with actual Kaplan-Meier plots. Results: The AUC for all institutions combined was 0.75, with individual institution AUCs ranging from 0.67 to 0.83. Nomogram predictions for each risk quadrant were similar to actual freedom from recurrence rates: predicted probabilities of 87% (low-risk group), 64% (intermediate-low-risk group), 39% (intermediate-high-risk group), and 14% (high-risk group) corresponded to actual rates of 86%, 64%, 42%, and 17%, respectively. The use of neoadjuvant therapy, variation in the prostate-specific antigen recurrence definitions between institutions, and minor differences in the way the Gleason grade was reported did not substantially affect the predictive accuracy of the nomogram. Conclusion: The nomogram is accurate when applied at international treatment institutions with similar patient selection and management strategies. Despite the potential for heterogeneity in patient selection and management, most predictions demonstrated high concordance with actual observations. Our results demonstrate that accurate predictions may be expected across different patient populations. © 2002 by American Society of Clinical Oncology.
Keywords: adult; cancer survival; controlled study; human tissue; aged; aged, 80 and over; disease-free survival; middle aged; survival analysis; major clinical study; clinical feature; cancer recurrence; area under the curve; patient selection; validation process; diagnostic accuracy; preoperative evaluation; prostate specific antigen; neoplasm recurrence, local; proportional hazards models; risk factors; prediction; risk assessment; cancer hormone therapy; prostatic neoplasms; prostatectomy; adjuvant chemotherapy; predictive value of tests; hormone; nomogram; roc curve; receiver operating characteristic; prostate carcinoma; humans; prognosis; human; male; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 20
Issue: 15
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2002-08-01
Start Page: 3206
End Page: 3212
Language: English
DOI: 10.1200/jco.2002.12.019
PUBMED: 12149292
PROVIDER: scopus
DOI/URL:
Notes: Export Date: 14 November 2014 -- Source: Scopus
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MSK Authors
  1. Markus Graefen
    11 Graefen
  2. Peter T Scardino
    622 Scardino
  3. Bernard Bochner
    328 Bochner
  4. James Eastham
    429 Eastham
  5. Michael W Kattan
    218 Kattan