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Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
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953
The EMPaCT Classifier: A Validated Tool to Predict Postoperative Prostate Cancer-related Death Using Competing-risk
Lorenzo Tosco1, Annouschka Laenen2, Alberto Briganti3
1Department of Urology, University Hospitals Leuven, Leuven, Belgium; Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium.
European Urology Focus
|July 30, 2017
Summary
A new model accurately predicts prostate cancer death after surgery for high-risk patients. This tool helps guide follow-up care and adjuvant treatments, improving patient management after radical prostatectomy (RP) and pelvic lymph node dissection (PLND).
Area of Science:
- Oncology
- Urology
- Prognostic Modeling
Background:
- Accurate survival prediction post-radical prostatectomy (RP) is crucial for multimodal therapy decisions.
- A significant need exists for tools to predict prostate cancer-related death (PCRD) in high-risk patients.
- Current prognostic tools are insufficient for guiding treatment intensification in high-risk prostate cancer.
Purpose of the Study:
- To develop and validate a prognostic model for predicting PCRD.
- The model integrates pathological features and utilizes competing-risks analysis.
- To provide a tool for better patient counseling and treatment tailoring.
Main Methods:
- Retrospective multi-institutional observational cohort study of 5876 patients with high-risk prostate cancer undergoing RP and pelvic lymph node dissection (PLND).
- A multivariate model with competing-risks correction was built using pathological high-risk features (pT3b-4, Gleason score ≥8, pN1).
- A simplified model with distinct prognostic groups (good, intermediate, poor) was derived and validated using eightfold cross-validation.
Main Results:
- The final cohort included 2823 patients after applying exclusion criteria.
- pT3b-4, Gleason score ≥8, and pN1 were identified as independent predictors of PCRD.
- The simplified model demonstrated excellent median accuracy of 88% upon cross-validation, categorizing patients into good, intermediate, and poor prognosis groups.
Conclusions:
- A novel, easy-to-use prognostic instrument for predicting PCRD after RP+PLND was developed and validated.
- This model enables clinicians to provide accurate patient counseling on follow-up intensity.
- The prognostic tool aids in tailoring adjuvant treatments for high-risk prostate cancer patients.
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