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Preoperative and postoperative nomograms incorporating surgeon experience for clinically localized prostate cancer
Author(s) -
Kattan Michael W.,
Vickers Andrew J.,
Yu Changhong,
Bianco Fernando J.,
Cronin Angel M.,
Eastham James A.,
Klein Eric A.,
Reuther Alwyn M.,
Edson Pontes Jose,
Scardino Peter T.
Publication year - 2009
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24083
Subject(s) - nomogram , medicine , prostatectomy , concordance , prostate cancer , surgery , cancer , cohort , general surgery
Abstract BACKGROUND: Accurate preoperative and postoperative risk assessment has been critical for counseling patients regarding radical prostatectomy for clinically localized prostate cancer. In addition to other treatment modalities, neoadjuvant or adjuvant therapies have been considered. The growing literature suggested that the experience of the surgeon may affect the risk of prostate cancer recurrence. The purpose of this study was to develop and internally validate nomograms to predict the probability of recurrence, both preoperatively and postoperatively, with adjustment for standard parameters plus surgeon experience. METHODS: The study cohort included 7724 eligible prostate cancer patients treated with radical prostatectomy by 1 of 72 surgeons. For each patient, surgeon experience was coded as the total number of cases conducted by the surgeon before the patient's operation. Multivariable Cox proportional hazards regression models were developed to predict recurrence. Discrimination and calibration of the models was assessed following bootstrapping methods, and the models were presented as nomograms. RESULTS: In this combined series, the 10‐year probability of recurrence was 23.9%. The nomograms were quite discriminating (preoperative concordance index, 0.767; postoperative concordance index, 0.812). Calibration appeared to be very good for each. Surgeon experience seemed to have a quite modest effect, especially postoperatively. CONCLUSIONS: Nomograms have been developed that consider the surgeon's experience as a predictor. The tools appeared to predict reasonably well but were somewhat little improved with the addition of surgeon experience as a predictor variable. Cancer 2009. © 2009 American Cancer Society.