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MD NewslinePrognostic Significance of Surgery and Radiotherapy in Localized Prostate Cancer

Development of Predictive Nomograms for Survival Outcomes in Localized Prostate Cancer: Clinical Applications and Implications for Treatment Choices

A recent randomized controlled trial involving 90,434 patients with localized prostate cancer has developed effective nomograms to predict overall survival (OS) and cancer-specific survival (CSS) based on various clinical factors. The study highlights the prognostic significance of factors such as age, T stage, surgery, chemotherapy, radiotherapy, biopsy Gleason score, prostate-specific antigen (PSA), race, tumor grade, and marital status, offering valuable insights for optimizing treatment strategies.

Key Points:

  • Study Design: Conducted as a randomized controlled trial.
  • Participants: 90,434 patients diagnosed with localized prostate cancer.
  • Objective: Develop nomograms to predict risk factors for overall survival (OS) and cancer-specific survival (CSS).
  • Baseline Characteristics:
    • Training cohort: 63,328 patients.
    • Validation cohort: 27,106 patients.
    • Mean age: 71.4 ± 5.29 years.
    • Ethnicity: Majority White (78.3%).
    • Tumor grades: 18.97% grade I, 44.73% grade II, 36.27% grade III, 0.03% grade IV.
  • Prognostic Factors Identified via COX Regression Analysis:
    • Age, T stage, surgery, chemotherapy, radiotherapy, biopsy Gleason score, PSA, race, tumor grade, and marital status.
    • Independent risk factors for CSS: Gleason score, age, race, marital status, surgery, PSA, T stage, and radiotherapy.
    • Independent risk factors for OS: Age, race, Gleason score, PSA, marital status, surgery, and radiotherapy.
  • Nomogram Performance:
    • High discriminability strength validated through internal cross-validation, calibration curve, area under curve, and external temporal validation values.
  • Clinical Application:
    • Nomograms showed high potential for clinical use in predicting OS and CSS in localized prostate cancer.
    • OS and CSS rates higher in low-risk group patients compared to high-risk group patients in both training and validation cohorts.
    • Lowest OS and CSS rates observed in high-risk patients who did not undergo radiotherapy but received local irradiation.

“The discriminability strength of the nomogram was high, indicating its clinical potential for predicting localized prostate cancer outcomes.”

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