Journal
CHINESE MEDICAL JOURNAL
Volume 134, Issue 13, Pages 1576-1583Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CM9.0000000000001607
Keywords
Nomogram; PSA nadir; Tumor diameter; Magnetic resonance imaging; Biochemical recurrence; Radical prostatectomy
Categories
Funding
- Beijing Natural Science Foundation [Z200027]
- National Natural Science Foundation of China [61871004]
- National Key R&D Program of China [2018 YFC0115900]
- Innovation & Transfer Fund of Peking University Third Hospital [BYSYZHKC2020111]
- Peking University Medicine Fund of Fostering Young Scholars' Scientific & Technological Innovation [BMU2020PYB002]
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The study demonstrated that the newly developed nomogram significantly improved the accuracy in predicting BCRFS after RP, with PSA nadir and MTD based on MRI before surgery identified as independent predictors of BCR.
Background: Various prediction tools have been developed to predict biochemical recurrence (BCR) after radical prostatectomy (RP); however, few of the previous prediction tools used serum prostate-specific antigen (PSA) nadir after RP and maximum tumor diameter (MTD) at the same time. In this study, a nomogram incorporating MTD and PSA nadir was developed to predict BCR-free survival (BCRFS). Methods: A total of 337 patients who underwent RP between January 2010 and March 2017 were retrospectively enrolled in this study. The maximum diameter of the index lesion was measured on magnetic resonance imaging (MRI). Cox regression analysis was performed to evaluate independent predictors of BCR. A nomogram was subsequently developed for the prediction of BCRFS at 3 and 5 years after RP. Time-dependent receiver operating characteristic (ROC) curve and decision curve analyses were performed to identify the advantage of the new nomogram in comparison with the cancer of the prostate risk assessment post-surgical (CAPRA-S) score. Results: A novel nomogram was developed to predict BCR by including PSA nadir, MTD, Gleason score, surgical margin (SM), and seminal vesicle invasion (SVI), considering these variables were significantly associated with BCR in both univariate and multivariate analyses (P < 0.05). In addition, a basic model including Gleason score, SM, and SVI was developed and used as a control to assess the incremental predictive power of the new model. The concordance index of our model was slightly higher than CAPRA-S model (0.76 vs. 0.70, P = 0.02) and it was significantly higher than that of the basic model (0.76 vs. 0.66, P = 0.001). Time-dependent ROC curve and decision curve analyses also demonstrated the advantages of the new nomogram. Conclusions: PSA nadir after RP and MTD based on MRI before surgery are independent predictors of BCR. By incorporating PSA nadir and MTD into the conventional predictive model, our newly developed nomogram significantly improved the accuracy in predicting BCRFS after RP.
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