This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kattan, M. W. Articles by Leibel, S. A. Search for Related Content PubMed PubMed Citation Articles by Kattan, M. W. Articles by Leibel, S. A.

Pretreatment Nomogram for Predicting the Outcome of Three-Dimensional Conformal Radiotherapy in Prostate Cancer

From the Departments of Urology, Epidemiology and Biostatistics, and Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, and the Cleveland Clinic, Cleveland, OH.

Address reprint requests to Michael W. Kattan, PhD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave C1068, New York, NY 10021; email kattanm{at}mskcc.org

PURPOSE: Several studies have defined risk groups for predicting the outcome after external-beam radiotherapy of localized prostate cancer. However, most models formed patient risk groups, and none of these models considers radiation dose as a predictor variable. The purpose of this study was to develop a nomogram to improve the accuracy of predicting outcome after three-dimensional conformal radiotherapy.

MATERIALS AND METHODS: This study was a retrospective, nonrandomized analysis of patients treated at the Memorial Sloan-Kettering Cancer Center between 1988 and 1998. Clinical parameters of the 1,042 patients included stage, biopsy Gleason score, pretreatment serum prostate-specific antigen (PSA) level, whether neoadjuvant androgen deprivation therapy was administered, and the radiation dose delivered. Biochemical (PSA) treatment failure was scored when three consecutive rises of serum PSA occurred. A nomogram, which predicts the probability of remaining free from biochemical recurrence for 5 years, was validated internally on this data set using a bootstrapping method and externally using a cohort of patients treated at the Cleveland Clinic, Cleveland, OH.

RESULTS: When predicting outcomes for patients in the validation data set from the Cleveland Clinic, the nomogram had a Somers’ D rank correlation between predicted and observed failure times of 0.52. Predictions from this nomogram were more accurate (P < .0001) than the best of seven published risk stratification systems, which achieved a Somers’ D coefficient of 0.47.

CONCLUSION: The development process illustrated here produced a nomogram that seems to predict more accurately than other available systems and may be useful for treatment selection by both physicians and patients.

This article has been cited by other articles:

				S. J. Wang, C. D. Fuller, J.-S. Kim, D. F. Sittig, C. R. Thomas Jr, and P. M. Ravdin Prediction Model for Estimating the Survival Benefit of Adjuvant Radiotherapy for Gallbladder Cancer J. Clin. Oncol., May 1, 2008; 26(13): 2112 - 2117. [Abstract] [Full Text] [PDF]

				O. Riesterer, L. Milas, and K. K. Ang Use of Molecular Biomarkers for Predicting the Response to Radiotherapy With or Without Chemotherapy J. Clin. Oncol., September 10, 2007; 25(26): 4075 - 4083. [Abstract] [Full Text] [PDF]

				A. J. Stephenson, P. T. Scardino, M. W. Kattan, T. M. Pisansky, K. M. Slawin, E. A. Klein, M. S. Anscher, J. M. Michalski, H. M. Sandler, D. W. Lin, et al. Predicting the Outcome of Salvage Radiation Therapy for Recurrent Prostate Cancer After Radical Prostatectomy J. Clin. Oncol., May 20, 2007; 25(15): 2035 - 2041. [Abstract] [Full Text] [PDF]

				H. Hricak, P. L. Choyke, S. C. Eberhardt, S. A. Leibel, and P. T. Scardino Imaging Prostate Cancer: A Multidisciplinary Perspective Radiology, April 1, 2007; 243(1): 28 - 53. [Abstract] [Full Text] [PDF]

				T. M. Pisansky External-beam radiotherapy for localized prostate cancer. N. Engl. J. Med., October 12, 2006; 355(15): 1583 - 1591. [Full Text] [PDF]

				A. J. Stephenson, P. T. Scardino, J. A. Eastham, F. J. Bianco Jr., Z. A. Dotan, P. A. Fearn, and M. W. Kattan Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Natl Cancer Inst, May 17, 2006; 98(10): 715 - 717. [Abstract] [Full Text] [PDF]

				M. A. Rubin, T. A. Bismar, O. Andren, L. Mucci, R. Kim, R. Shen, D. Ghosh, J. T. Wei, A. M. Chinnaiyan, H.-O. Adami, et al. Decreased {alpha}-Methylacyl CoA Racemase Expression in Localized Prostate Cancer is Associated with an Increased Rate of Biochemical Recurrence and Cancer-Specific Death Cancer Epidemiol. Biomarkers Prev., June 1, 2005; 14(6): 1424 - 1432. [Abstract] [Full Text] [PDF]

				K. L. Zakian, K. Sircar, H. Hricak, H.-N. Chen, A. Shukla-Dave, S. Eberhardt, M. Muruganandham, L. Ebora, M. W. Kattan, V. E. Reuter, et al. Correlation of Proton MR Spectroscopic Imaging with Gleason Score Based on Step-Section Pathologic Analysis after Radical Prostatectomy Radiology, March 1, 2005; 234(3): 804 - 814. [Abstract] [Full Text] [PDF]

				J. M.G. Taylor, M. Yu, and H. M. Sandler Individualized Predictions of Disease Progression Following Radiation Therapy for Prostate Cancer J. Clin. Oncol., February 1, 2005; 23(4): 816 - 825. [Abstract] [Full Text] [PDF]

				T. Hoang, R. Xu, J. H. Schiller, P. Bonomi, and D. H. Johnson Clinical Model to Predict Survival in Chemonaive Patients With Advanced Non-Small-Cell Lung Cancer Treated With Third-Generation Chemotherapy Regimens Based on Eastern Cooperative Oncology Group Data J. Clin. Oncol., January 1, 2005; 23(1): 175 - 183. [Abstract] [Full Text] [PDF]

				T. L. DeWeese Radiation Therapy and Androgen Suppression as Treatment for Clinically Localized Prostate Cancer: The New Standard? JAMA, August 18, 2004; 292(7): 864 - 866. [Full Text] [PDF]

				H. I. Scher, M. Eisenberger, A. V. D'Amico, S. Halabi, E. J. Small, M. Morris, M. W. Kattan, M. Roach, P. Kantoff, K. J. Pienta, et al. Eligibility and Outcomes Reporting Guidelines for Clinical Trials for Patients in the State of a Rising Prostate-Specific Antigen: Recommendations From the Prostate-Specific Antigen Working Group J. Clin. Oncol., February 1, 2004; 22(3): 537 - 556. [Abstract] [Full Text] [PDF]

				M. W. Kattan, M. J. Zelefsky, P. A. Kupelian, D. Cho, P. T. Scardino, Z. Fuks, and S. A. Leibel Pretreatment Nomogram That Predicts 5-Year Probability of Metastasis Following Three-Dimensional Conformal Radiation Therapy for Localized Prostate Cancer J. Clin. Oncol., December 15, 2003; 21(24): 4568 - 4571. [Abstract] [Full Text] [PDF]

				M. W. Kattan, S. F. Shariat, B. Andrews, K. Zhu, E. Canto, K. Matsumoto, M. Muramoto, P. T. Scardino, M. Ohori, T. M. Wheeler, et al. The Addition of Interleukin-6 Soluble Receptor and Transforming Growth Factor Beta1 Improves a Preoperative Nomogram for Predicting Biochemical Progression in Patients With Clinically Localized Prostate Cancer J. Clin. Oncol., October 1, 2003; 21(19): 3573 - 3579. [Abstract] [Full Text] [PDF]

				M. W. Kattan, M. S. Karpeh, M. Mazumdar, and M. F. Brennan Postoperative Nomogram for Disease-Specific Survival After an R0 Resection for Gastric Carcinoma J. Clin. Oncol., October 1, 2003; 21(19): 3647 - 3650. [Abstract] [Full Text] [PDF]

				S. M.H. Alibhai, G. Naglie, R. Nam, J. Trachtenberg, and M. D. Krahn Do Older Men Benefit From Curative Therapy of Localized Prostate Cancer? J. Clin. Oncol., September 1, 2003; 21(17): 3318 - 3327. [Abstract] [Full Text] [PDF]

				M. J. Morris and H. I. Scher Clinical Approaches to Osseous Metastases in Prostate Cancer Oncologist, April 1, 2003; 8(2): 161 - 173. [Abstract] [Full Text] [PDF]

				M. J. Zelefsky and S. A. Leibel Comparing Contemporary Surgery to External-Beam Radiotherapy for Clinically Localized Prostate Cancer J. Clin. Oncol., August 15, 2002; 20(16): 3363 - 3364. [Full Text] [PDF]

				P. A. Kupelian, M. Elshaikh, C. A. Reddy, C. Zippe, and E. A. Klein Comparison of the Efficacy of Local Therapies for Localized Prostate Cancer in the Prostate-Specific Antigen Era: A Large Single-Institution Experience With Radical Prostatectomy and External-Beam Radiotherapy J. Clin. Oncol., August 15, 2002; 20(16): 3376 - 3385. [Abstract] [Full Text] [PDF]

				C. J. Logothetis Challenge of Locally Persistent Prostate Cancer: An Unresolved Clinical Dilemma J. Clin. Oncol., August 1, 2002; 20(15): 3187 - 3187. [Full Text] [PDF]

				M. Graefen, P. I. Karakiewicz, I. Cagiannos, D. I. Quinn, S. M. Henshall, J. J. Grygiel, R. L. Sutherland, P. D. Stricker, E. Klein, P. Kupelian, et al. International Validation of a Preoperative Nomogram for Prostate Cancer Recurrence After Radical Prostatectomy J. Clin. Oncol., August 1, 2002; 20(15): 3206 - 3212. [Abstract] [Full Text] [PDF]

				I. Cagiannos, M. Graefen, P. I. Karakiewicz, M. Ohori, J. A. Eastham, F. Rabbani, W. Fair, T. M. Wheeler, P. G. Hammerer, A. Haese, et al. Analysis of Clinical Stage T2 Prostate Cancer: Do Current Subclassifications Represent an Improvement? J. Clin. Oncol., April 15, 2002; 20(8): 2025 - 2030. [Abstract] [Full Text] [PDF]