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Updated: Jul 12, 2026
Establishing a Competing Risk Regression Nomogram Model for Survival Data
Published on: October 23, 2020
TRUS-Clinical Nomogram: A Tool for Predicting Bone Metastasis in Prostate Cancer
Yu Li1,2, Wensheng Yue2, Fang Yang2
1Department of Ultrasound, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, 637000 Nanchong, Sichuan, China.
Background:
Bone metastasis (BM) is a common complication associated with advanced prostate cancer (PCa). The multiparametric features of transrectal ultrasound (TRUS) in PCa patients with BM remain poorly characterized. This study examined the presence of TRUS in patients with BM and developed a clinical nomogram for risk assessment.
Methods:
From December 2021 to September 2023, 114 consecutive patients with pathologically confirmed PCa were enrolled in this study. Based on the bone scan results, the patients were classified into BM (n = 56) and non-BM (n = 58) groups. Clinical, baseline TRUS, and transrectal contrast-enhanced ultrasound (TR-CEUS) data were recorded. Predictors of BM were identified using univariate and multivariate logistic regression. A nomogram was developed and internally validated via bootstrap resampling (1000 repetitions). The performance of the model was assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).
Results:
The results of the multivariate analysis revealed three independent predictors of BM, which included elevated total prostate-specific antigen (T-PSA) (odds ratio (OR) = 4.745, 95% CI: 2.177-10.344, p = 0.018), higher Gleason score (GS) (OR = 1.844, 95% CI: 1.144-2.970, p = 0.012), and TR-CEUS wash-in presence (OR = 3.268, 95% CI: 1.014-10.538, p = 0.047). The nomogram that incorporated these predictors showed strong discrimination, with an area under the curve (AUC) of 0.899 (95% CI: 0.841-0.96) in the development cohort and 0.859 (95% CI: 0.765-0.968) upon internal validation. Calibration was satisfactory, and the model offered significant net clinical benefits.
Conclusions:
We found that TR-CEUS wash-in is an independent predictor of BM in PCa patients. Based on the clinical parameters T-PSA, GS, and TR-CEUS, a nomogram might provide a clinical reference for accurately assessing BM.
Clinical Trial Registration:
This study was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn) (Registration No. ChiCTR 2400082813).
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