J Korean Med Sci.  2010 Oct;25(10):1443-1448. 10.3346/jkms.2010.25.10.1443.

Preoperative Nomograms for Predicting Extracapsular Extension in Korean Men with Localized Prostate Cancer: A Multi-institutional Clinicopathologic Study

• Chung JS
• Choi HY
• Song HR
• Byun SS
• Seo SI
• Song C
• Cho JS
• Lee SE
• Ahn H
• Lee ES
• Kim WJ
• Chung MK
• Jung TY
• Yu HS
• Choi YD

• KMID: 2157847
• DOI: http://doi.org/10.3346/jkms.2010.25.10.1443

Abstract

We developed a nomogram to predict the probability of extracapsular extension (ECE) in localized prostate cancer and to determine when the neurovascular bundle (NVB) may be spared. Total 1,471 Korean men who underwent radical prostatectomy for prostate cancer between 1995 and 2008 were included. We drew nonrandom samples of 1,031 for nomogram development, leaving 440 samples for nomogram validation. With multivariate logistic regression analyses, we made a nomogram to predicts the ECE probability at radical prostatectomy. Receiver operating characteristic (ROC) analyses were also performed to assess the predictive value of each variable alone and in combination. The internal validation was performed from 200 bootstrap re-samples and the external validation was also performed from the another cohort. Overall, 314 patients (30.5%) had ECE. Age, Prostate specific antigen (PSA), biopsy Gleason score, positive core ratio, and maximum percentage of biopsy tumor were independent predictors of the presence of ECE (all P values <0.05). The nomogram predicted ECE with good discrimination (an area under the ROC curve of 0.777). Our nomogram allows for the preoperative identification of patients with an ECE and may prove useful in selecting patients to receive nerve sparing radical prostatectomy.

Keyword

Nomograms; Patient Selection; Prostatic neoplasms; Prostatectomy

MeSH Terms

Aged
Area Under Curve
Humans
Logistic Models
Male
Middle Aged
Nomograms
Predictive Value of Tests
Preoperative Period
Prostate-Specific Antigen/blood
Prostatectomy
Prostatic Neoplasms/*pathology/surgery
Republic of Korea

Figure

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  Fig. 1 Receiver operating characteristics (ROC) curve of multivariate logistic regression model (MLRM) for predicting extracapsular extension (ECE) in prostate cancer.

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  Fig. 2 Nomogram for predicting ECE in localized prostate cancer. Find the position of each variable on the corresponding axis, draw a line to the 'points' axis for the number of points, add the points from all the variables together and draw a line from the 'total points' axis to determine the extracapsular extension probabilities at the bottom.

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  Fig. 3 (A) Calibration curves of preoperative nomogram in internal validation cohort. The x-axis is the predicted probability from the nomogram, and the y-axis is the actual probability of ECE. The dashed line represents performance of the ideal nomogram (predicted outcome perfectly corresponds with actual outcome). The dotted line represents the apparent accuracy of our nomogram without correction for over fit. The solid line represents bootstrap-corrected performance of our nomogram. (B) Calibration plot of nomogram in external validation cohort (n=440). Solid line indicates logistic calibration curve and dotted line represent data for validation cohort.

Reference

1. Walsh PC, Lepor H, Eggleston JC. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate. 1983. 4:473–485.

2. Goharderakhshan RZ, Sudilovsky D, Carroll LA, Grossfeld GD, Marn R, Carroll PR. Utility of intraoperative frozen section analysis of surgical margins in region of neurovascular bundles at radical prostatectomy. Urology. 2002. 59:709–714.

3. Hernandez DJ, Epstein JI, Trock BJ, Tsuzuki T, Carter HB, Walsh PC. Radical retropubic prostatectomy. How often do experienced surgeons have positive surgical margins when there is extraprostatic extension in the region of the neurovascular bundle? J Urol. 2005. 173:446–449.

4. Tsuzuki T, Hernandez DJ, Aydin H, Trock B, Walsh PC, Epstein JI. Prediction of extraprostatic extension in the neurovascular bundle based on prostate needle biopsy pathology, serum prostate specific antigen and digital rectal examination. J Urol. 2005. 173:450–453.

5. Kattan MW, Eastham JA, Stapleton AM, Wheeler TM, Scardino PT. A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J Natl Cancer Inst. 1998. 90:766–771.

6. Taneja SS, Penson DF, Epelbaum A, Handler T, Lepor H. Does site specific labeling of sextant biopsy cores predict the site of extracapsular extension in radical prostatectomy surgical specimen. J Urol. 1999. 162:1352–1357.

7. Graefen M, Haese A, Pichlmeier U, Hammerer PG, Noldus J, Butz K, Erbersdobler A, Henke RP, Michl U, Fernandez S, Huland H. A validated strategy for side specific prediction of organ confined prostate cancer: a tool to select for nerve sparing radical prostatectomy. J Urol. 2001. 165:857–863.

8. Wu AH, Whittemore AS, Kolonel LN, John EM, Gallagher RP, West DW, Hankin J, Teh CZ, Dreon DM, Paffenbarger RS Jr. Serum androgens and sex hormone-binding globulins in relation to lifestyle factors in older African-American, white, and Asian men in the United States and Canada. Cancer Epidemiol Biomarkers Prev. 1995. 4:735–741.

9. Lee SE, Kwak C, Park MS, Lee CH, Kang W, Oh SJ. Ethnic differences in the age-related distribution of serum prostate-specific antigen values: a study in a healthy Korean male population. Urology. 2000. 56:1007–1010.

10. Robbins AS, Koppie TM, Gomez SL, Parikh-Patel A, Mills PK. Differences in prognostic factors and survival among white and Asian men with prostate cancer, California, 1995-2004. Cancer. 2007. 110:1255–1263.

11. Song C, Kang T, Ro JY, Lee MS, Kim CS, Ahn H. Nomograms for the prediction of pathologic stage of clinically localized prostate cancer in Korean men. J Korean Med Sci. 2005. 20:262–266.

12. Jung KW, Won YJ, Park S, Kong HJ, Sung J, Shin HR, Park EC, Lee JS. Cancer statistics in Korea: Incidence, Mortality and Survival in 2005. J Korean Med Sci. 2009. 24:995–1003.

13. Ku JH, Ahn JO, Lee CH, Lee NK, Park YH, Byun SS, Kwak C, Lee SE. Distribution of serum prostate-specific antigen in healthy Korean men: influence of ethnicity. Urology. 2002. 60:475–479.

14. Chang YL, Lin AT, Chen KK, Chang YH, Wu HH, Kuo JY, Huang WJ, Lu SH, Hsu YS, Chung HJ, Chang SC. Correlation between serum prostate specific antigen and prostate volume in Taiwanese men with biopsy proven benign prostatic hyperplasia. J Urol. 2006. 176:196–199.

15. Gupta A, Aragaki C, Gotoh M, Masumori N, Ohshima S, Tsukamoto T, Roehrborn CG. Relationship between prostate specific antigen and indexes of prostate volume in Japanese men. J Urol. 2005. 173:503–506.

16. Ohori M, Kattan MW, Koh H, Maru N, Slawin KM, Shariat S, Muramoto M, Reuter VE, Wheeler TM, Scardino PT. Predicting the presence and side of extracapsular extension: a nomogram for staging prostate cancer. J Urol. 2004. 171:1844–1849.

17. Naya Y, Slaton JW, Troncoso P, Okihara K, Babaian RJ. Tumor length and location of cancer on biopsy predict for side specific extraprostatic cancer extension. J Urol. 2004. 171:1093–1097.

18. Sebo TJ, Bock BJ, Cheville JC, Lohse C, Wollan P, Zincke H. The percent of cores positive for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy. J Urol. 2000. 163:174–178.

19. Robbins AS, Koppie TM, Gomez SL, Parikh-Patel A, Mills PK. Differences in prognostic factors and survival among white and Asian men with prostate cancer, California, 1995-2004. Cancer. 2007. 110:1255–1263.

20. Ward JF, Zincke H, Bergstralh EJ, Slezak JM, Myers RP, Blute ML. The impact of surgical approach (nerve bundle preservation versus wide local excision) on surgical margins and biochemical recurrence following radical prostatectomy. J Urol. 2004. 172:1328–1332.

21. Steyerberg EW, Harrell FE Jr, Borsboom GJ, Eijkemans MJ, Vergouwe Y, Habbema JD. Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol. 2001. 54:774–781.

22. Villers A, McNeal JE, Redwine EA, Freiha FS, Stamey TA. The role of perineural space invasion in the local spread of prostatic adenocarcinoma. J Urol. 1989. 142:763–768.

23. Rosen MA, Goldstone L, Lapin S, Wheeler T, Scardino PT. Frequency and location of extracapsular extension and positive surgical margins in radical prostatectomy specimens. J Urol. 1992. 148:331–337.

24. Hall GS, Kramer CE, Epstein JI. Evaluation of radical prostatectomy specimens. A comparative analysis of sampling methods. Am J Surg Pathol. 1992. 16:315–324.

25. McNeal JE, Villers AA, Redwine EA, Freiha FS, Stamey TA. Capsular penetration in prostate cancer. Significance for natural history and treatment. Am J Surg Pathol. 1990. 14:240–247.