A nomogram to predict Gleason sum upgrading of clinically diagnosed localized prostate cancer among Chinese patients

Abstract

Although several models have been developed to predict the probability of Gleason sum upgrading between biopsy and radical prostatectomy specimens, most of these models are restricted to prostate-specific antigen screening-detected prostate cancer. This study aimed to build a nomogram for the prediction of Gleason sum upgrading in clinically diagnosed prostate cancer. The study cohort comprised 269 Chinese prostate cancer patients who underwent prostate biopsy with a minimum of 10 cores and were subsequently treated with radical prostatectomy. Of all included patients, 220 (81.8%) were referred with clinical symptoms. The prostate-specific antigen level, primary and secondary biopsy Gleason scores, and clinical T category were used in a multivariate logistic regression model to predict the probability of Gleason sum upgrading. The developed nomogram was validated internally. Gleason sum upgrading was observed in 90 (33.5%) patients. Our nomogram showed a bootstrap-corrected concordance index of 0.789 and good calibration using 4 readily available variables. The nomogram also demonstrated satisfactory statistical performance for predicting significant upgrading. External validation of the nomogram published by Chun et al. in our cohort showed a marked discordance between the observed and predicted probabilities of Gleason sum upgrading. In summary, a new nomogram to predict Gleason sum upgrading in clinically diagnosed prostate cancer was developed, and it demonstrated good statistical performance upon internal validation.

Developing a Correct System to Evaluate the Accuracy of Gleason Score in Prostate Cancer of Chinese Population

“…Significant differences were found between the 2 groups (p < 0.001). Consistent with a previous study, Wang et al [23] demonstrated that Gleason sum upgrading in patients with low or intermediate-grade disease was significant. When applied to this subgroup, our correct system showed satisfactory discrimination and application.…”

Predicting Gleason score upgrade from biopsy pathology to radical prostatectomy specimens: a new nomogram and internal validation

“…Clinical T-stage is an important variable as for predicting prognosis and guiding treatment decisions. It is also predictive for Gleason upgrade found in several studies [4,[8][9][10]12] . It is acknowledged that advanced T stage is correlated with large tumor volume, which could bring di culties in sampling small Gleason patterns.…”

“…PSA is a widely used indicator for risk strati cation and different outcomes in PCa. As for predicting GS change, PSA might also play a role [4][5][6][7][8][9][10][11][12] . In current study, we found that PSA was also predictive and increased PSA was strongly correlated with GSU.…”

“…Plenty of studies have investigated manifold variables which could have impacts on the GS upgrade from biopsy to prostatectomy. However, the ndings of independent predictors were controversial [4][5][6][7][8][9][10][11][12][13][14] . Models and nomograms were built in recent years, seldom of which included pathological and imaging variables [ 9-12, 15, 16] .…”

Development and validation of a nomogram for predicting the survival of patients with non-metastatic nasopharyngeal carcinoma after curative treatment

“…However, internal validation, such as cross-validation and bootstrap resampling, has a theoretical probability of overinterpretation [9]. Therefore, external validation is more appropriate for examining the model applicability, e.g., using a data set from other institutions or a validation set by the data-splitting method from the same institution, especially when the sample size is large [7, 13]. In this study, we calibrated the nomogram with a validation set and an IMRT cohort from the same institution that were independent from the training set.…”