Journal of Clinical Oncology, Vol 20, Issue 15
(August), 2002: 3206-3212
© 2002 American Society for Clinical Oncology
International Validation of a Preoperative Nomogram for Prostate Cancer Recurrence After Radical Prostatectomy
By Markus Graefen,
Pierre I. Karakiewicz,
Ilias Cagiannos,
David I. Quinn,
Susan M. Henshall,
John J. Grygiel,
Robert L. Sutherland,
Phillip D. Stricker,
Eric Klein,
Patrick Kupelian,
Donald G. Skinner,
Gary Lieskovsky,
Bernard Bochner,
Hartwig Huland,
Peter G. Hammerer,
Alexander Haese,
Andreas Erbersdobler,
James A. Eastham,
Jean de Kernion,
Thomas Cangiano,
Fritz H. Schröder,
Mark F. Wildhagen,
Theo H. van der Kwast,
Peter T. Scardino,
Michael W. Kattan
From the Departments of Urology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY; Garvan Institute of Medical Research and St Vincent’s Hospital, Sydney, Australia; Cleveland Clinic, Cleveland, OH; University of Southern California, and University of California, Los Angeles, CA; University Hospital, Hamburg-Eppendorf, Germany; Louisiana State University Health Science Center, Shreveport, LA; and Department of Urology, Erasmus University, and Academic Hospital Rotterdam, the Netherlands.
Address reprint requests to Michael W. Kattan, PhD, Departments of Urology, Epidemiology, and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021; email: kattanm{at}mskcc.org
PURPOSE: We evaluated the predictive accuracy of a recently published preoperative nomogram for prostate cancer that predicts 5-year freedom from recurrence. We applied this nomogram to patients from seven different institutions spanning three continents.
METHODS: Clinical data of 6,754 patients were supplied for validation, and 6,232 complete records were used. Nomogram-predicted probabilities of 60-month freedom from recurrence were compared with actual follow-up in two ways. First, areas under the receiver operating characteristic curves (AUCs) were determined for the entire data set according to several variables, including the institution where treatment was delivered. Second, nomogram classification–based risk quadrants were compared with actual Kaplan-Meier plots.
RESULTS: The AUC for all institutions combined was 0.75, with individual institution AUCs ranging from 0.67 to 0.83. Nomogram predictions for each risk quadrant were similar to actual freedom from recurrence rates: predicted probabilities of 87% (low-risk group), 64% (intermediate-low–risk group), 39% (intermediate-high–risk group), and 14% (high-risk group) corresponded to actual rates of 86%, 64%, 42%, and 17%, respectively. The use of neoadjuvant therapy, variation in the prostate-specific antigen recurrence definitions between institutions, and minor differences in the way the Gleason grade was reported did not substantially affect the predictive accuracy of the nomogram.
CONCLUSION: The nomogram is accurate when applied at international treatment institutions with similar patient selection and management strategies. Despite the potential for heterogeneity in patient selection and management, most predictions demonstrated high concordance with actual observations. Our results demonstrate that accurate predictions may be expected across different patient populations.
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