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- Jelovsek, J Eric, et al.
(författare)
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Predicting Risk of Pelvic Floor Disorders 12 and 20 Years after Delivery.
- 2018
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Ingår i: American journal of obstetrics and gynecology. - : Elsevier BV. - 1097-6868 .- 0002-9378. ; 218:2
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Tidskriftsartikel (refereegranskat)abstract
- Little progress has been made in preventing pelvic floor disorders despite their significant health and economic impact. Identifying women at risk remains a key element in targeting prevention and planning health resource allocation strategies. Although events around the time of childbirth are clinically recognized as important predictors, it is difficult to counsel women and intervene around the time of childbirth due to an inability to accurately convey a patient's risk in the presence of multiple risk factors and the long time lapse, often decades, between obstetric events and the onset of pelvic floor disorders later in life. Prediction models and scoring systems have been used in other areas of medicine to identify patients at risk for chronic diseases. Models have been developed for use before delivery that predict short-term risk of pelvic floor disorders after childbirth but no models predicting long-term risk exist.To use variables known before and during childbirth to develop and validate prognostic models estimating risks of these disorders 12 and 20 years after delivery.Obstetric variables were collected from two cohorts: 1) women who gave birth in the United Kingdom and New Zealand (n=3763) and 2) women from the Swedish Medical Birth Register (n=4991). Pelvic floor disorders were self-reported 12 years after childbirth in the UK/NZ cohort and 20 years after childbirth in the Swedish Register. The cohorts were split so that data during the first half of the cohort's time period were used to fit prediction models and validation was performed from the second half (temporal validation). As there is currently no consensus on how to best define pelvic floor disorders from a patient's perspective, we chose to fit the data for each model using multiple outcome definitions for prolapse, urinary incontinence, fecal incontinence, 1 or more pelvic floor disorder and 2 or more pelvic floor disorders. Model accuracy was measured: 1) by ranking an individual's risk among all subjects in the cohort (discrimination) using a concordance index and 2) by observing whether the predicted probability was too high or low (calibration) at a range of predicted probabilities using visual plots.Models were able to discriminate between women who developed bothersome symptoms or received treatment, at 12 and 20 years respectively, for: pelvic organ prolapse (concordance indices 0.570, 0.627), urinary incontinence (concordance indices 0.653, 0.689), fecal incontinence (concordance indices 0.618, 0.676), ≥1 pelvic floor disorders (concordance indices 0.639, 0.675) and ≥2 pelvic floor disorders (concordance indices 0.635, 0.619). The discriminatory ability of all models is shown in Table 2. Route of delivery and family history of each pelvic floor disorder were strong predictors in most models. Urinary incontinence before and during the index pregnancy was a strong predictor for developing all pelvic floor disorders in most models 12 years after delivery. The 12 and 20-year bothersome or treatment for prolapse models were accurate when providing predictions for risk from 0% to approximately 15%. The 12-year and 20-year primiparous model began to over-predict when risk rates reached 20%. When predicting bothersome symptoms or treatment for urinary incontinence, the 12-year models were accurate when predictions ranged from approximately 5% to 60% and 20-year primiparous models were accurate between 5% and 80%. For bothersome symptoms or treatment for fecal incontinence, the 12 and 20-year models were accurate between 1% and 15% risk and began to over-predict at rates above 15% and 20%, respectively.Models may provide an opportunity before birth to identify women at low risk of developing pelvic floor disorders and institute prevention strategies such as pelvic floor muscle training, weight control or elective cesarean section for women at higher risk. Models are provided at: http://riskcalc.org/UR_CHOICE/.
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- Stephenson, Andrew J, et al.
(författare)
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Defining biochemical recurrence of prostate cancer after radical prostatectomy: a proposal for a standardized definition
- 2006
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Ingår i: Journal of Clinical Oncology. - 1527-7755. ; 24:24, s. 3973-3978
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Prostate-specific antigen (PSA) defined biochemical recurrence (BCR) of prostate cancer is widely used for reporting the outcome of radical prostatectomy (RP). A standardized BCR definition is lacking, and overall progression-free probability and risk of subsequent metastatic disease progression may vary greatly depending on the PSA criterion used. Ten definitions of BCR were evaluated to identify the one that best explains metastatic progression. METHODS: Of 3,125 patients who underwent RP at our institution since 1985, 75 developed distant metastasis during a median follow-up of 49 months. To predict metastasis progression, we modeled the clinical information using multivariable Cox regression analysis. BCR was included in the model as a time-dependent covariate, and separate models were developed for each definition. A goodness-of-fit (R2) statistic was used to determine the Cox model (and thereby the BCR definition) that best explained metastatic progression. RESULTS: The 10-year progression-free probability ranged from 63% to 79%, depending on the BCR definition. The model containing BCR defined as a PSA of at least 0.4 ng/mL followed by another increase best explained metastatic progression (R2 = 0.21). This definition was also associated with a high probability of subsequent secondary therapy, continued PSA progression, and rapid PSA doubling time. CONCLUSION: BCR defined as a PSA value of at least 0.4 ng/mL followed by another increase best explains the development of distant metastasis among 10 candidate definitions, after controlling for clinical variables and the use of secondary therapy. On the basis of this evidence, we propose that this definition be adopted as the standard for reporting the outcome of RP.
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- Steuber, Thomas, et al.
(författare)
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Free PSA isoforms and intact and cleaved forms of urokinase plasminogen activator receptor in serum improve selection of patients for prostate cancer biopsy
- 2007
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Ingår i: International Journal of Cancer. - : Wiley. - 0020-7136. ; 120:7, s. 1499-1504
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Tidskriftsartikel (refereegranskat)abstract
- Clinicians currently use simple cut-points, such as serum prostate-specific antigen (PSA) >= 4 ng/ml, to decide whether to recommend further work-up for prostate cancer (PCa). As an alternative strategy, we evaluated multivariable models giving probabilities of a PCa diagnosis based on PSA and several circulating novel biomarkers. We measured total PSA, free PSA (fPSA), fPSA subfractions (single-chain fPSA-I and multichain fPSA-N), total human glandular kallikrein 2 (hK2) and full-length and cleaved forms of soluble urokinase plasminogen activator receptor (suPAR) in pretreatment serum from 355 men referred for prostate biopsy. Age and total PSA were combined in a "base" regression model to predict biopsy outcome. We then compared this base model to models supplemented by various combinations of circulating markers, using concordance index (AUC) to measure diagnostic discrimination. PCa prediction was significantly enhanced by models supplemented by measurements of suPAR fragments and fPSA isoforms. Addition of these markers improved bootstrap-corrected AUC from 0.611 for a cut-point and 0.706 for the base model to 0.754 for the full model (p = 0.005). This improved diagnostic accuracy was also seen in subanalysis of patients with PSA 2-9.99 ng/ml and normal findings on DRE (0.652 vs. 0.715, p = 0.039). In this setting, hK2 did not add diagnostic information. Measurements of individual forms of suPAR and PSA isoforms contributed significantly to discrimination of men with PCa from those with no evidence of malignancy. (c) 2007 Wiley-Liss, Inc.
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- Vickers, Andrew J, et al.
(författare)
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The relationship between prostate-specific antigen and prostate cancer risk: the Prostate Biopsy Collaborative Group.
- 2010
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Ingår i: Clinical cancer research : an official journal of the American Association for Cancer Research. - 1078-0432. ; 16:17, s. 4374-81
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Tidskriftsartikel (refereegranskat)abstract
- The relationship between prostate-specific antigen (PSA) level and prostate cancer risk remains subject to fundamental disagreements. We hypothesized that the risk of prostate cancer on biopsy for a given PSA level is affected by identifiable characteristics of the cohort under study.
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