Prostate Cancer Nomograms Are Still Alive

IF 2.1 4区 医学 Q2 SURGERY
D. Castellani
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In multivariate analysis, race, marital status, summary stage, American Joint Committee on Cancer (AJCC) stage, lymph node stage, biopsy Gleason score, and treatment were significantly associated with overall survival, whereas AJCC stage, lymph node stage, biopsy Gleason score, and treatment were associated with cancer-specific survival. The above variables were used to build nomograms aiming to predict 5-, 8-, and 10-year overall and cancer-specific survival. Using receiver operating characteristic curve analysis, the authors found that the discriminative ability of their nomograms was moderately accurate in predicting overall survival and highly accurate in predicting cancer-specific survival. The performance of nomograms was confirmed by the validation group. Nomograms are currently widely used in urologic oncology, particularly in the decision-making process and patient counseling [4]. In the diagnostic phase, nomograms using clinical parameters are useful to assess the risk of clinically significant PCa at biopsy [4], and nomograms that include multiparametric magnetic resonance imaging data have been recently introduced [5,6]. Post-diagnosis decision-making is a crucial aspect in PCa patients, mostly to stratify the risk of progression and to offer advice on the possible management of clinically localized disease [4]. Post-treatment prognostic nomograms were also developed for detecting patients at risk of lymph node invasion, presence of positive surgical, margin, extracapsular extension, and biochemical recurrence after radical prostatectomy [7]. Prognostic nomograms are more accurate than staging systems in predicting the progression of PCa. Being continuous prediction methods, nomograms are more appropriate to predict progression compared with staging systems, because grouping patients predisposes to reduce the predictive accuracy of a prognostic model [8]. In fact, Liu et al. confirmed that the constructed nomograms demonstrated to have a better predictive ability in predicting overall and cancer-specific survival than AJCC TNM and Gleason score [3]. Notably, their analysis failed to show any influence of baseline prostate-specific antigen (PSA) in predicting survival. This might be correlated to a large number of patients in the validation group who had a PSA ≥20 ng/ml at diagnosis (94%). Despite this, more than half of included patients were biopsy Gleason score ≤ 6 (55.6%), and a minority of cases were T3-4 (12.3%), had lymph node (19.2%), or systemic metastasis (2.0%). Still using the SEER database data between 2010 and 2015, Hu et al. found that PSA was significantly associated with poor prognosis in 23,730 men younger than 55 years [9]. The authors developed an effective prognostic nomogram that included PSA, marital status, AJCC stage, Gleason score, and surgery to predict 1-,3-, and 5-year overall survival. This discrepancy can be partially related to the lower number of included patients in Liu’s model which may lead to an overfitting model. Finally, Liu’s nomograms lack data on systemic therapy, making them inappropriate for metastatic patients requiring such a therapy. Despite the aforementioned limitations, the authors should be congratulated for providing a useful tool to assess PCa prognosis in very young men, covering a gap in the literature. We hope that the authors wish to implement their work by building a desktop or handheld software for a fast and easy application of their nomograms in daily clinical practice. The era of nomograms is not over, PCa nomograms are still alive.","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 1","pages":"1591 - 1592"},"PeriodicalIF":2.1000,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Investigative Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/08941939.2022.2071508","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0

Abstract

Prostate cancer (PCa) is the second most common cancer worldwide, with an estimated incidence of 30.7 new cases per 100,000 men in 2020 [1]. The highest incidence rates were reported in Northern and Western Europe, the Caribbean, Australia, and New Zealand [2]. PCa shows a steady increase with age but a non-neglectable number of men aged 20–50 years are currently diagnosed and die of PCa, with an estimated worldwide number of deaths of 2770 men in 2020 in this range of age [1]. Li et. al established nomograms to predict overall and cancer-specific survival in PCa patients aged <50 years at diagnosis [3]. The authors used data from The Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2016. 8259 patients were included and randomly divided into two groups (training and validation group) at a ratio of 7:3. In multivariate analysis, race, marital status, summary stage, American Joint Committee on Cancer (AJCC) stage, lymph node stage, biopsy Gleason score, and treatment were significantly associated with overall survival, whereas AJCC stage, lymph node stage, biopsy Gleason score, and treatment were associated with cancer-specific survival. The above variables were used to build nomograms aiming to predict 5-, 8-, and 10-year overall and cancer-specific survival. Using receiver operating characteristic curve analysis, the authors found that the discriminative ability of their nomograms was moderately accurate in predicting overall survival and highly accurate in predicting cancer-specific survival. The performance of nomograms was confirmed by the validation group. Nomograms are currently widely used in urologic oncology, particularly in the decision-making process and patient counseling [4]. In the diagnostic phase, nomograms using clinical parameters are useful to assess the risk of clinically significant PCa at biopsy [4], and nomograms that include multiparametric magnetic resonance imaging data have been recently introduced [5,6]. Post-diagnosis decision-making is a crucial aspect in PCa patients, mostly to stratify the risk of progression and to offer advice on the possible management of clinically localized disease [4]. Post-treatment prognostic nomograms were also developed for detecting patients at risk of lymph node invasion, presence of positive surgical, margin, extracapsular extension, and biochemical recurrence after radical prostatectomy [7]. Prognostic nomograms are more accurate than staging systems in predicting the progression of PCa. Being continuous prediction methods, nomograms are more appropriate to predict progression compared with staging systems, because grouping patients predisposes to reduce the predictive accuracy of a prognostic model [8]. In fact, Liu et al. confirmed that the constructed nomograms demonstrated to have a better predictive ability in predicting overall and cancer-specific survival than AJCC TNM and Gleason score [3]. Notably, their analysis failed to show any influence of baseline prostate-specific antigen (PSA) in predicting survival. This might be correlated to a large number of patients in the validation group who had a PSA ≥20 ng/ml at diagnosis (94%). Despite this, more than half of included patients were biopsy Gleason score ≤ 6 (55.6%), and a minority of cases were T3-4 (12.3%), had lymph node (19.2%), or systemic metastasis (2.0%). Still using the SEER database data between 2010 and 2015, Hu et al. found that PSA was significantly associated with poor prognosis in 23,730 men younger than 55 years [9]. The authors developed an effective prognostic nomogram that included PSA, marital status, AJCC stage, Gleason score, and surgery to predict 1-,3-, and 5-year overall survival. This discrepancy can be partially related to the lower number of included patients in Liu’s model which may lead to an overfitting model. Finally, Liu’s nomograms lack data on systemic therapy, making them inappropriate for metastatic patients requiring such a therapy. Despite the aforementioned limitations, the authors should be congratulated for providing a useful tool to assess PCa prognosis in very young men, covering a gap in the literature. We hope that the authors wish to implement their work by building a desktop or handheld software for a fast and easy application of their nomograms in daily clinical practice. The era of nomograms is not over, PCa nomograms are still alive.
前列腺癌nomograph仍然存在
前列腺癌(PCa)是全球第二大常见癌症,预计到2020年,每10万名男性中有30.7例新发病例。据报道,发病率最高的是北欧和西欧、加勒比地区、澳大利亚和新西兰。随着年龄的增长,前列腺癌呈稳步增长趋势,但不可忽视的是,目前有20-50岁的男性被诊断并死于前列腺癌,估计到2020年,全世界这一年龄段的男性死亡人数为2770人。Li等人建立了图来预测诊断时年龄<50岁的前列腺癌患者的总生存率和癌症特异性生存率。作者使用了2004年至2016年监测、流行病学和最终结果(SEER)数据库中的数据。纳入8259例患者,按7:3的比例随机分为两组(训练组和验证组)。在多变量分析中,种族、婚姻状况、总结分期、美国癌症联合委员会(AJCC)分期、淋巴结分期、活检Gleason评分和治疗与总生存率显著相关,而AJCC分期、淋巴结分期、活检Gleason评分和治疗与癌症特异性生存率相关。以上变量用于构建旨在预测5年、8年和10年总体和癌症特异性生存的nomogram。使用受试者工作特征曲线分析,作者发现他们的nomogram鉴别能力在预测总体生存时是中等准确的,在预测癌症特异性生存时是高度准确的。经验证组确认图的性能。nomography目前广泛应用于泌尿肿瘤学,特别是在决策过程和患者咨询中。在诊断阶段,使用临床参数的x线图可用于评估活检bb0处临床显著性PCa的风险,并且最近引入了包含多参数磁共振成像数据的x线图[5,6]。诊断后决策是前列腺癌患者的一个重要方面,主要是对进展风险进行分层,并就临床局限性疾病bbb的可能管理提供建议。治疗后的预后x线图也被用于检测患者是否有淋巴结浸润、手术阳性、边缘、囊外延伸和根治性前列腺切除术后生化复发的风险。在预测前列腺癌的进展方面,预后图比分期系统更准确。作为一种连续预测方法,nomogram与分期系统相比更适合于预测病情进展,因为对患者进行分组容易降低预后模型bbb的预测准确性。事实上,Liu等人证实,构建的nomogram在预测总体和癌症特异性生存方面比AJCC TNM和Gleason评分bb0有更好的预测能力。值得注意的是,他们的分析没有显示基线前列腺特异性抗原(PSA)对预测生存率有任何影响。这可能与验证组中诊断时PSA≥20 ng/ml的大量患者(94%)有关。尽管如此,超过一半的患者活检Gleason评分≤6(55.6%),少数病例为T3-4(12.3%),有淋巴结(19.2%)或全身转移(2.0%)。Hu等人仍然使用2010 - 2015年的SEER数据库数据,在23,730名年龄小于55岁的男性中发现PSA与预后不良显著相关。作者开发了一种有效的预后图,包括PSA、婚姻状况、AJCC分期、Gleason评分和手术,以预测1年、3年和5年总生存率。这种差异可能部分与Liu的模型中纳入的患者数量较少有关,这可能导致模型过拟合。最后,Liu的nomograph缺乏系统治疗的数据,使得它不适合需要这种治疗的转移性患者。尽管存在上述局限性,但作者应该为评估非常年轻男性前列腺癌预后提供有用的工具而表示祝贺,这弥补了文献中的空白。我们希望作者希望通过建立一个桌面或手持软件来实现他们的工作,以便在日常临床实践中快速简便地应用他们的图。谱图的时代还没有结束,PCa谱图仍然存在。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.20
自引率
0.00%
发文量
114
审稿时长
6-12 weeks
期刊介绍: Journal of Investigative Surgery publishes peer-reviewed scientific articles for the advancement of surgery, to the ultimate benefit of patient care and rehabilitation. It is the only journal that encompasses the individual and collaborative efforts of scientists in human and veterinary medicine, dentistry, basic and applied sciences, engineering, and law and ethics. The journal is dedicated to the publication of outstanding articles of interest to the surgical research community.
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