Korean Nomogram for Prediction of Biochemical Recurrence of Clinically Localized Prostate Cancer in Koreans with Emphasis on International Variation of Prostate Cancer
Yong Mee Cho, Soo Jin Jung, Namhoon Cho, Min-ju Kim, Michael WW Kattan, Changhong Yu, Jae Y Ro. University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; Inje University Paik Hospital, Pusan, Republic of Korea; Yonsei University, Seoul, Republic of Korea; Cleveland Clinic, Cleveland, OH; Methodist Hospital and Weill Medical College of Cornell University, Houston, TX
Background: Korean prostate cancer has been rising rapidly in incidence with aggressive clinicopathologic features compared to Western countries. This study aimed to summarize clinicopathologic features of clinically localized Korean prostate cancer cases and to provide a predictive nomogram for biochemical recurrence (BCR)-free survival based on their prognostic factors.
Design: A nationwide multicenter study was designed on 730 clinically localized Korean prostate cancer cases that had undergone radical prostatectomy. The Cox proportional hazards model was applied on 550 cases from four heavy volume institutions to define clinicopathologic prognostic factors and to develop the Korean nomogram, which was validated through internal validation, external validation using a separate 295 cases, and head-to-head comparison to updated Kattan nomogram.
Results: Among 730 cases, BCR was developed in 257 cases (35.2%) during 57.6 months of mean follow-up. A significant proportion of the cases had aggressive pathologic features with Gleason score (GS) ≥ 8 in 202 cases (27.7%) and pathologic tumor stage (pT) 3 in 297 cases (40.7%). On a multivariable analysis, preoperative PSA, pT, GS, and LVI as well remained as independent prognostic factors and used to develop Korean nomogram in conjunction with age and surgical margin status. The Korean nomogram performed well in predicting BCR-free 5 and 10 year survivals on internal validation (c-statistics: 0.70 and 0.67, respectively). On external validation, the Korean nomogram showed better calibration than the updated Kattan nomogram albeit with lower discrimination power.
Conclusions: In addition to preoperative PSA, pT, and GS, LVI was an independent prognostic factor for BCR in clinically localized Korean prostate cancer. The better performance of the Korean nomogram for Korean prostate cancer patients suggests that international variation on clinicopathologic factors should be reflected in a predictive nomogram.
Category: Genitourinary (including renal tumors)
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 80, Tuesday Morning