Accurate prediction tools in prostate cancer require consistent assessment of included variables

• Objective: The aim of this study was to create a preoperative prediction model predicting extraprostatic tumour growth in men with clinically organ-confined disease from a prospectively collected Swedish cohort. Materials and methods: The study used data from 3386 men in the prospective multi-centre Laparoscopic Prostatectomy Robot Open (LAPPRO) trial, with 14 participating urological departments. External validation was performed using a cohort of 634 men from the largest study centre with patients who underwent surgery before and after the inclusion period of the LAPPRO study. External validation of the updated Partin table was used for comparison. The prediction models were created by multivariable logistic regression. Nomogram prediction performance, internal, internal-external and external validation are presented as the area under the receiver operating characteristic curve (AUC). Results: The nomogram reached a prediction performance with an AUC of 0.741, with internal and external validation of 0.738 and 0.698, respectively. Internal-external validation showed great divergence between centres, with AUCs ranging from 0.476 to 0.892, indicating inconsistencies in pathological staging or one or more of the included variables in the regression model. When including centre as a variable in the multivariable model it was significantly associated with the outcome of pT3 (p<0.001). AUC for external validation of the Partin table was 0.694. Conclusions: Accurate prediction tools in prostate cancer require consistent assessment of included variables, and local validation is needed before the use of such tools in clinical practice.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Urology and Nephrology (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

Nyckelord

Clinically organ-confined disease

extraprostatic extension

multivariable logistic regression

nomogram

prediction model

preoperative variables

prostate cancer

validation

radical prostatectomy

extracapsular extension

external validation

partin tables

neurovascular bundles

incremental value

imaging

findings

preservation

nomograms

men

Urology & Nephrology

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