Nomograms are superior to staging and risk grouping systems for identifying high-risk patients: preoperative application in prostate cancer

被引:171
作者
Kattan, MW
机构
[1] Mem Sloan Kettering Canc Ctr, Hlth Outcomes Res Grp, Dept Epidemiol & Biostat, New York, NY 10021 USA
[2] Mem Sloan Kettering Canc Ctr, Dept Urol, New York, NY 10021 USA
关键词
clinical design trial; prediction;
D O I
10.1097/00042307-200303000-00005
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose of review We outline a generic approach to using a nomogram to predict a continuous probability of failure in high-risk patients (rather than putting patients into groups), in order to identify patients whose risk exceeds a cutoff point. We discuss the goals of any staging system, what markers should be included, and models of markers. Recent findings Selection of high-risk patients for any cancer has traditionally been accomplished by the creation of risk groups, or perhaps clinical stages. Ideally, high-risk patients should be identified as accurately as possible, because of the treatment and psychological implications for the patient. We argue that a continuous multivariable prediction model, such as a nomogram, is the most appropriate and accurate way to select high-risk patients. This type of model predicts outcome more accurately than risk grouping or staging systems. As an example, we use our preoperative prostatic specific antigen recurrence nomogram to identify patients at high risk of biochemical failure, who are in need of an effective neoadjuvant therapy. Summary It will follow from our discussion that identification of high-risk patients should follow four simple steps. First, select the endpoint of interest for the trial or the patient. Second, select the method that predicts the endpoint as accurately as possible. Third, determine the cutoff of predicted probability beyond which it makes sense to give the patient experimental therapy. Fourth, offer the novel therapy to the patient whose prediction of the endpoint, using the most accurate prediction method, exceeds the threshold.
引用
收藏
页码:111 / 116
页数:6
相关论文
共 18 条
[1]  
Begg CB, 2000, STAT MED, V19, P1997, DOI 10.1002/1097-0258(20000815)19:15<1997::AID-SIM511>3.0.CO
[2]  
2-C
[3]  
BLUTE ML, 1999, J UROLOGY, V154, P1591
[4]   Development of a nomogram that predicts the probability of a positive prostate biopsy in men with an abnormal digital rectal examination and a prostate-specific antigen between 0 and 4 ng/mL [J].
Eastham, JA ;
May, R ;
Robertson, JL ;
Sartor, O ;
Kattan, MW .
UROLOGY, 1999, 54 (04) :709-713
[5]   International validation of a preoperative nomogram for prostate cancer recurrence after radical prostatectomy [J].
Graefen, M ;
Karakiewicz, PI ;
Cagiannos, I ;
Quinn, DI ;
Henshall, SM ;
Grygiel, JJ ;
Sutherland, RL ;
Stricker, PD ;
Klein, E ;
Kupelian, P ;
Skinner, DG ;
Lieskovsky, G ;
Bochner, B ;
Huland, H ;
Hammerer, PG ;
Haese, A ;
Erbersdobler, A ;
Eastham, JA ;
de Kernion, J ;
Cangiano, T ;
Schröder, FH ;
Wildhagen, MF ;
van der Kwast, TH ;
Scardino, PT ;
Kattan, MW .
JOURNAL OF CLINICAL ONCOLOGY, 2002, 20 (15) :3206-3212
[6]   A validation of two preoperative nomograms predicting recurrence following radical prostatectomy in a cohort of European men [J].
Graefen, M ;
Karakiewicz, PI ;
Cagiannos, I ;
Hammerer, PG ;
Haese, A ;
Palisaar, J ;
Fernandez, S ;
Noldus, J ;
Erbersdobler, A ;
Huland, H ;
Scardino, PT ;
Kattan, MW .
UROLOGIC ONCOLOGY, 2002, 7 (04) :141-146
[7]   A postoperative prognostic nomogram for renal cell carcinoma [J].
Kattan, MW ;
Reuter, V ;
Motzer, RJ ;
Katz, J ;
Russo, P .
JOURNAL OF UROLOGY, 2001, 166 (01) :63-67
[8]   A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer [J].
Kattan, MW ;
Eastham, JA ;
Stapleton, AMF ;
Wheeler, TM ;
Scardino, PT .
JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, 1998, 90 (10) :766-771
[9]   Postoperative nomogram for 12-year sarcoma-specific death [J].
Kattan, MW ;
Leung, DHY ;
Brennan, MF .
JOURNAL OF CLINICAL ONCOLOGY, 2002, 20 (03) :791-796
[10]   Pretreatment nomogram for predicting the outcome of three-dimensional conformal radiotherapy in prostate cancer [J].
Kattan, MW ;
Zelefsky, MJ ;
Kupelian, PA ;
Scardino, PT ;
Fuks, Z ;
Leibel, SA .
JOURNAL OF CLINICAL ONCOLOGY, 2000, 18 (19) :3352-3359