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• W1514151925 abstract "Tamblyn and colleagues 1 use a population of 635 South Australian radical prostatectomy patients to validate and compare the performance of three published statistical tools 2-4 designed to predict the probability of 3-year post-radical prostatectomy biochemical recurrence (BCR) using preoperative clinical and biopsy data. The authors find that all three statistical tools achieve a similar accuracy in discriminating between South Australian patients in terms of higher or lower risk, producing high concordance indices of 74.4% to 79.1%. However, the performance of the tools varied considerably when calibration was assessed. While the 3-year BCR predictions of the 1998 Kattan nomogram 2 closely matched the actuarial probabilities calculated for South Australian patients, predictions were overestimated by the 2005 CAPRA model 3 and underestimated by the 2006 Stephenson nomogram 4. These trends were most pronounced for high risk patients where the use of such nomograms is most relevant. This paper illustrates the fact that extrapolation of published international results to local practice is a known pitfall that has potential to mislead both practitioners and patients. The complexities of multistep procedures involving several surgical interventions (biopsy and radical prostatectomy) each performed by different clinicians in separate practices and accompanied by independent pathological interpretation will probably lead to significant variation from results published by other institutions. We found a similar degree of over-optimism in estimating the 3-year probability of BCR for high risk radical prostatectomy patients during validation of the 2009 Kattan postoperative nomogram on our West Australian population 5. Similar to the issues discussed by Tamblyn et al. 1, we attributed this calibration discrepancy to a variety of differences between our patient population and the cohort used for Kattan nomogram development, including the facts that West Australian clinicians define BCR around a postoperative PSA level of 0.2 ng/mL rather than 0.4 ng/mL and seldom perform extended lymph node dissection. Our approach was to develop a nomogram more suited for use with West Australian patients, which did not use lymph node involvement as a predictive variable and was designed to predict time to BCR at a PSA level of 0.2 ng/mL 5. While Tamblyn et al. 1 found that the performance of the 1998 Kattan nomogram was accurate for the 635 patients in their validation cohort despite the South Australian definition of BCR at a PSA level of 0.2 ng/mL and rising, they were forced to exclude 300 more recently treated patients because data on clinical stage were not routinely available in patient case notes. Perhaps South Australian clinicians and patients would also benefit from development of a preoperative nomogram using more locally relevant patient data." @default.
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• W1514151925 date "2011-11-01" @default.
• W1514151925 modified "2023-10-10" @default.
• W1514151925 title "COMPARATIVE ANALYSIS OF THREE RISK ASSESSMENT TOOLS IN AUSTRALIAN PATIENTS WITH PROSTATE CANCER" @default.
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• W1514151925 doi "https://doi.org/10.1111/j.1464-410x.2011.10717.x" @default.
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