Joniau S., Briganti A., Gontero P., Gandaglia G., Tosco L., Fieuws S., Tombal B., Marchioro G., Walz J., Kneitz B., Bader P., Frohneberg D., Tizzani A., Graefen M., Van Cangh P., Karnes R.J., Montorsi F., Van Poppel H., Spahn M.
European Urology 2015 67:1 (157-164)
Background High-risk prostate cancer (PCa) is an extremely heterogeneous disease. A clear definition of prognostic subgroups is mandatory. Objective To develop a pretreatment prognostic model for PCa-specific survival (PCSS) in high-risk PCa based on combinations of unfavorable risk factors. Design, setting, and participants We conducted a retrospective multicenter cohort study including 1360 consecutive patients with high-risk PCa treated at eight European high-volume centers. Intervention Retropubic radical prostatectomy with pelvic lymphadenectomy. Outcome measurements and statistical analysis Two Cox multivariable regression models were constructed to predict PCSS as a function of dichotomization of clinical stage (<cT3 vs cT3-4), Gleason score (GS) (2-7 vs 8-10), and prostate-specific antigen (PSA ? 20 ng/ml vs > 20 ng/ml). The first “extended” model includes all seven possible combinations; the second “simplified” model includes three subgroups: a good prognosis subgroup (one single high-risk factor); an intermediate prognosis subgroup (PSA > 20 ng/ml and stage cT3-4); and a poor prognosis subgroup (GS 8-10 in combination with at least one other high-risk factor). The predictive accuracy of the models was summarized and compared. Survival estimates and clinical and pathologic outcomes were compared between the three subgroups. Results and limitations The simplified model yielded an R of…(vermás)