Pretreament nomogram for predicting the outcome of three-dimensional conformal radiotherapy in prostate cancer Journal Article

Authors: Kattan, M. W.; Zelefsky, M. J.; Kupelian, P. A.; Scardino, P. T.; Fuks, Z.; Leibel, S. A.
Article Title: Pretreament nomogram for predicting the outcome of three-dimensional conformal radiotherapy in prostate cancer
Abstract: Purpose: Several studies have defined risk groups for predicting the outcome after external-beam radiotherapy of localized prostate cancer. However, most models formed patient risk groups, and none of these models considers radiation dose as a predictor variable. The purpose of this study was to develop a nomogram to improve the accuracy of predicting outcome after three-dimensional conformal radiotherapy. Materials and Methods: This study was a retrospective, nonrandomized analysis of patients treated at the Memorial Sloan-Keltering Cancer Center between 1988 and 1998. Clinical parameters of the 1,042 patients included stage, biopsy Gleason score, pretreatment serum prostate-specific antigen (PSA) level, whether neoadjuvant androgen deprivation therapy was administered, and the radiation dose delivered. Biochemical (PSA) treatment failure was scored when three consecutive rises of serum PSA occurred. A nomogram, which predicts the probability of remaining free from biochemical recurrence for 5 years, was validated internally on this data set using a bootstrapping method and externally using a cohort of patients treated at the Cleveland Clinic, Cleveland, OH. Results: When predicting outcomes for patients in the validation data set from the Cleveland Clinic, the nomogram had a Somers' D rank correlation between predicted and observed failure times of 0.52. Predictions from this nomogram were more accurate (P < .0001) than the best of seven published risk stratification systems, which achieved a Somers' D coefficient of 0.47. Conclusion: The development process illustrated here produced a nomogram that seems to predict more accurately than other available systems and may be useful for treatment selection by both physicians and patients. (C) 2000 by American Society of Clinical Oncology.
Keywords: adult; controlled study; human tissue; treatment outcome; aged; aged, 80 and over; disease-free survival; middle aged; treatment failure; retrospective studies; major clinical study; cancer recurrence; adjuvant therapy; disease free survival; radiation dose; neoadjuvant therapy; methodology; diagnostic accuracy; reproducibility; prostate specific antigen; reproducibility of results; proportional hazards models; retrospective study; risk; prostate cancer; prostate-specific antigen; prostatic neoplasms; blood; immunology; proportional hazards model; statistical analysis; prostate tumor; prostate biopsy; scoring system; prediction and forecasting; predictive value of tests; radiotherapy, conformal; antineoplastic agents, hormonal; computer assisted radiotherapy; nomogram; antineoplastic hormone agonists and antagonists; beam therapy; humans; human; male; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 18
Issue: 19
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2000-10-19
Start Page: 3352
End Page: 3359
Language: English
PUBMED: 11013275
PROVIDER: scopus
Notes: Export Date: 18 November 2015 -- Source: Scopus