Korean J Urol.  2007 Aug;48(8):789-796. 10.4111/kju.2007.48.8.789.

Development of Nomogram for Predicting Pathologic Outcome using Prostate-specific Antigen, Gleason Score, and the Percentage of Positive Core in the Clinically Confined Prostate Cancers, and Comparison with Nomogram using Existing Factors

• Jeong SJ
• Han BK
• Yu JH
• Han JH
• Chang IH
• Hong SK
• Byun SS
• Lee SE

• KMID: 2061271
• DOI: http://doi.org/10.4111/kju.2007.48.8.789

Abstract

PURPOSE
There have been reports that clinical stages do not reflect patients' postoperative prognosis well. On the contrary, the clinical application of the percentage of positive core(%(+) core), which predicts tumor volume has been increasing. We developed nomogram for predicting pathologic outcome using prostate-specific antigen(PSA), Gleason score and %(+) core based on data of radical prostatectomy and compared it with nomogram using clinical stage instead of %(+) core.
MATERIALS AND METHODS
Two hundred and fifty nine patients with clinically confined prostate cancers were included in the study. Nomogram for predicting pathologic outcome was developed through multinominal logistic regression analysis, and pathologic outcomes were extracapsular invasion(ECE), seminal vesicle invasion(SVI) and bladder neck invasion(BNI). The accuracy of each nomogram for predicting each pathologic outcome was compared on the basis of receiver operating characteristic(ROC) curve analysis.
RESULTS
The mean %(+) core was 24.6% and clinical stages T1c, T2a,b and T2c were 58.7%, 32.0% and 9.3%, respectively. ECE was observed in 45(17.4%), SVI in 9(3.5%), and BNI in 12(4.6%). With an increase in PSA, Gleason score, clinical stage, or %(+) core, the incidence of extraprostatic involvement increased gradually. Two nomograms for predicting pathologic outcome were developed. In quantifying expected predictive improvement, area under ROC curve for predicting ECE was greater in the nomogram using %(+) core than clinical stage(0.815 vs. 0.778). These values for predicting SVI were 0.886 and 0.760, respectively, and for predicting BNI, 0.743 and 0.764, respectively.
CONCLUSIONS
We developed nomogram for predicting pathologic outcomes using %(+) core instead of clinical stage. Nomogram using %(+) core predicted ECE and SVI with greater accuracy than nomogram using clinical stage.

Keyword

Prostate cancer; Surgical pathology; Nomograms

MeSH Terms

Humans
Incidence
Logistic Models
Neck
Neoplasm Grading*
Nomograms*
Pathology, Surgical
Prognosis
Prostate*
Prostate-Specific Antigen*
Prostatectomy
Prostatic Neoplasms*
ROC Curve
Seminal Vesicles
Tumor Burden
Urinary Bladder
Prostate-Specific Antigen

Figure

• 

  Fig. 1 Receiver operating characteristic curve analysis for comparison of two nomograms for predicting extracapsular extension in clinically confined tumor. Substantial improvement of 3.7% for the nomogram using % (+) core (AUC 0.815) compared with the nomogram using clinical stage (AUC 0.778) was noted. PSA: prostate- specific antigen, GS: Gleason score, % (+) core: percentage of positive core, AUC: area under curve.

• 

  Fig. 2 Receiver operating characteristic curve analysis for comparison of two nomograms for predicting seminal vesicle invasion in clinically confined tumor. Substantial improvement of 12.6% for the nomogram using % (+) core (AUC 0.886) compared with the nomogram using clinical stage (AUC 0.760) was noted. PSA: prostate- specific antigen, GS: Gleason score, % (+) core: percentage of positive core, AUC: area under curve.

• 

  Fig. 3 Receiver operating characteristic curve analysis for comparison of two nomograms for predicting bladder neck invasion in clinically confined tumor. Accuracy of the nomogram using % (+) core (AUC 0.743) decreased by 2.1% compared with the nomogram using clinical stage (AUC 0.764). PSA: prostate-specific antigen, GS: Gleason score, % (+) core: percentage of positive core, AUC: area under curve.

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