Prognostic significance of surgery and radiotherapy in elderly patients with localized prostate cancer: establishing and time-based external validation a nomogram from SEER-based study
Chenghao Zhanghuang,
Jianjun Zhu,
Ye Li,
Jinkui Wang,
Jing Ma,
Li Li,
Zhigang Yao,
Fengming Ji,
Chengchuang Wu,
Haoyu Tang,
Yucheng Xie,
Bing Yan,
Zhen Yang
Affiliations
Chenghao Zhanghuang
Department of Urology, Kunming Children’s Hospital (Children’s Hospital affiliated to Kunming Medical University)
Jianjun Zhu
Department of Oncology; Yunnan Children solid Tumor Treatment Center, Kunming Children’s Hospital (Children’s Hospital affiliated to Kunming Medical University), Kunming Children’s Solid Tumor Diagnosis and Treatment Center
Ye Li
Department of Oncology; Yunnan Children solid Tumor Treatment Center, Kunming Children’s Hospital (Children’s Hospital affiliated to Kunming Medical University), Kunming Children’s Solid Tumor Diagnosis and Treatment Center
Jinkui Wang
Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering; Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Department of Urology, Children’s Hospital of Chongqing Medical University
Jing Ma
Yunnan Key Laboratory of Children’s Major Disease Research, Kunming Children’s Hospital (Children’s Hospital affiliated to Kunming Medical University); Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming Children’s Solid Tumor Diagnosis and Treatment Center, Yunnan Clinical Medical Center for Pediatric Diseases
Li Li
Yunnan Key Laboratory of Children’s Major Disease Research, Kunming Children’s Hospital (Children’s Hospital affiliated to Kunming Medical University); Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming Children’s Solid Tumor Diagnosis and Treatment Center, Yunnan Clinical Medical Center for Pediatric Diseases
Zhigang Yao
Department of Urology, Kunming Children’s Hospital (Children’s Hospital affiliated to Kunming Medical University)
Fengming Ji
Department of Urology, Kunming Children’s Hospital (Children’s Hospital affiliated to Kunming Medical University)
Chengchuang Wu
Department of Urology, Kunming Children’s Hospital (Children’s Hospital affiliated to Kunming Medical University)
Haoyu Tang
Department of Urology, Kunming Children’s Hospital (Children’s Hospital affiliated to Kunming Medical University)
Yucheng Xie
Department of Pathology, Kunming Children’s Hospital (Children’s Hospital affiliated to Kunming Medical University)
Bing Yan
Department of Urology, Kunming Children’s Hospital (Children’s Hospital affiliated to Kunming Medical University)
Zhen Yang
Department of Oncology; Yunnan Children solid Tumor Treatment Center, Kunming Children’s Hospital (Children’s Hospital affiliated to Kunming Medical University), Kunming Children’s Solid Tumor Diagnosis and Treatment Center
Abstract Objective Prostate cancer (PC) is a significant disease affecting men’s health worldwide. More than 60% of patients over 65 years old and more than 80% are diagnosed with localized PC. The current choice of treatment modalities for localized PC and whether overtreatment is controversial. Therefore, we wanted to construct a nomogram to predict the risk factors associated with cancer-specific survival (CSS) and overall survival (OS) in elderly patients with localized PC while assessing the survival differences in surgery and radiotherapy for elderly patients with localized PC. Methods Data of patients with localized PC over 65 years were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression models were used to determine independent risk factors for CSS and OS. Nomograms predicting CSS and OS were built using multivariate Cox regression models. The consistency index (C-index), the area under the subject operating characteristic curve (AUC), and the calibration curve were used to test the accuracy and discrimination of the prediction model. Decision curve analysis (DCA) was used to test the potential clinical value of this model. Results A total of 90,434 patients over 65 years and diagnosed with localized PC from 2010 to 2018 were included in the study. All patients were randomly assigned to the training set (n = 63,328) and the validation set (n = 27,106). Univariate and multivariate Cox regression model analysis showed that age, race, marriage, T stage, surgical, radiotherapy, prostate-specific antigen (PSA), and Gleason score (GS) were independent risk factors for predicting CSS in elderly patients with localized PC. Age, race, marriage, surgery, radiotherapy, PSA, and GS were independent risk factors for predicting OS in elderly patients with localized PC. The c-index of the training and validation sets for the predicted CSS is 0.802(95%CI:0.788–0.816) and 0.798(95%CI:0.776–0.820, respectively). The c-index of the training and validation sets for predicting OS is 0.712(95%:0.704–0.720) and 0.724(95%:0.714–0.734). It shows that the nomograms have excellent discriminatory ability. The AUC and the calibration curves also show good accuracy and discriminability. Conclusion We have developed new nomograms to predict CSS and OS in elderly patients with localized PC. After internal validation and external temporal validation with reasonable accuracy, reliability and potential clinical value, the model can be used for clinically assisted decision-making.
