This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Walz, J. Articles by Karakiewicz, P. I. Search for Related Content PubMed PubMed Citation Articles by Walz, J. Articles by Karakiewicz, P. I. Related Articles Related Editorial Related Correspondence Social Bookmarking                            What's this?

A Nomogram Predicting 10-Year Life Expectancy in Candidates for Radical Prostatectomy or Radiotherapy for Prostate Cancer

Jochen Walz, Andrea Gallina, Fred Saad, Francesco Montorsi, Paul Perrotte, Shahrokh F. Shariat, Claudio Jeldres, Markus Graefen, Francois Bénard, Michael McCormack, Luc Valiquette, Pierre I. Karakiewicz

From the Cancer Prognostics and Health Outcomes Unit; Department of Urology, University of Montreal, Montreal, Quebec, Canada; Department of Urology; Martini Clinic, Prostate Cancer Center, University Medical Centre Eppendorf, Hamburg, Germany; Department of Urology, Vita-Salute University, Milan, Italy; and the Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX

Address reprint requests to Pierre I. Karakiewicz, MD, FRCSC, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montréal, Québec, Canada H2X 3J4; e-mail: pierre.karakiewicz{at}umontreal.ca

Purpose Candidates for definitive therapy for localized prostate cancer (PCa) should have life expectancy (LE) in excess of 10 years. However, LE estimation is difficult. To circumvent this problem, we developed a nomogram predicting 10-year LE for patients treated with either radical prostatectomy (RP) or external-beam radiation therapy (EBRT) and compared it with an existing tool.

Patients and Methods Between 1989 and 2000, 9,131 men were treated with either RP (n = 5,955) or EBRT (n = 3,176), without any secondary therapy and all deaths were considered unrelated to PCa. Age and Charlson comorbidity index (CCI) predicted 10-year LE in Cox regression models. We used 200 bootstrap resamples to internally validate the nomogram.

Results Median age was 66 years, median CCI was 1, median follow-up was 5.9 years and median actuarial survival was 13.8 years. Advanced age (P < .001), elevated CCI score (P < .001) and treatment type (EBRT v RP, P < .001) were independent predictors of poor 10 year LE. The nomogram predicting 10 year LE after either RP or EBRT was 84.3% accurate in split sample validation and was 2.9% (P = .007) more accurate than the existing tool. A cutoff of 70% or less was 84% accurate in identifying men who did not survive beyond 10 years.

Conclusion Our nomogram can accurately identify those individuals who do not have sufficient LE to warrant definitive PCa treatment and can help optimizing therapy decision-making.

J.W. and A.G. contributed equally to this article.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Editorial

• Predicting Outcomes in Prostate Cancer: How Many More Nomograms Do We Need?
  Robert W. Ross and Philip W. Kantoff
  JCO 2007 25: 3563-3564 [Full Text]

Related Correspondence

• Life Expectancy Estimation by Nomogram
  Michael Froehner
  JCO 2008 26: 690 [Full Text]
• Family Physicians Could Help in Predicting Life Expectancy Without Prostate Cancer
  Ravinder Mohan
  JCO 2008 26: 690-691 [Full Text]

This article has been cited by other articles:

				R. Mohan, H. Beydoun, M. L. Barnes-Ely, L. Lee, J. W. Davis, R. Lance, and P. Schellhammer Patients' Survival Expectations before Localized Prostate Cancer Treatment by Treatment Status J Am Board Fam Med, May 1, 2009; 22(3): 247 - 256. [Abstract] [Full Text] [PDF]

				O. Zivanovic, M. M. Leitao, A. Iasonos, L. M. Jacks, Q. Zhou, N. R. Abu-Rustum, R. A. Soslow, M. M. Juretzka, D. S. Chi, R. R. Barakat, et al. Stage-Specific Outcomes of Patients With Uterine Leiomyosarcoma: A Comparison of the International Federation of Gynecology and Obstetrics and American Joint Committee on Cancer Staging Systems J. Clin. Oncol., April 20, 2009; 27(12): 2066 - 2072. [Abstract] [Full Text] [PDF]

				M. Froehner Life Expectancy Estimation by Nomogram J. Clin. Oncol., February 1, 2008; 26(4): 690 - 690. [Full Text] [PDF]

				N. Suardi, C. Jeldres, P. I. Karakiewicz, and S. Shariat In Reply J. Clin. Oncol., February 1, 2008; 26(4): 691 - 693. [Full Text] [PDF]

				R. Mohan Family Physicians Could Help in Predicting Life Expectancy Without Prostate Cancer J. Clin. Oncol., February 1, 2008; 26(4): 690 - 691. [Full Text] [PDF]

				A. V. D'Amico, M.-H. Chen, A. A. Renshaw, M. Loffredo, and P. W. Kantoff Androgen Suppression and Radiation vs Radiation Alone for Prostate Cancer: A Randomized Trial JAMA, January 23, 2008; 299(3): 289 - 295. [Abstract] [Full Text] [PDF]

				R. W. Ross and P. W. Kantoff Predicting Outcomes in Prostate Cancer: How Many More Nomograms Do We Need? J. Clin. Oncol., August 20, 2007; 25(24): 3563 - 3564. [Full Text] [PDF]