Development and internal validation of prediction models for biochemical failure and composite failure after focal salvage high intensity focused ultrasound for local radiorecurrent prostate cancer: Presentation of risk scores for individual patient prognoses.

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Title: Development and internal validation of prediction models for biochemical failure and composite failure after focal salvage high intensity focused ultrasound for local radiorecurrent prostate cancer: Presentation of risk scores for individual patient prognoses.
Author(s): Peters, M
Kanthabalan, A
Shah, TT
McCartan, N
Moore, CM
Arya, M
Van der Voort van Zyp, JR
Moerland, MA
Hindley, RG
Emberton, M
Ahmed, HU
Item Type: Journal Article
Abstract: PURPOSE: Patient selection for focal salvage remains difficult. Therefore, we developed and internally validated prediction models for biochemical failure (BF) and a composite endpoint (CE) following focal salvage high intensity focused ultrasound (HIFU) for radiorecurrent prostate cancer. MATERIALS AND METHODS: A prospective HIFU registry identified 150 cases (November 2006-August 2015). Recurrence was assessed with multiparametric magnetic resonance imaging (MRI) combined with template prostate mapping biopsies, targeted biopsies, or systematic transrectal ultrasound-guided biopsies. Metastatic disease was ruled out with a positron emission tomography-computed tomography and a bone scan. Focal salvage HIFU consisted of quadrant-ablation, hemi-ablation, or index-lesion ablation. Cox-regression was used for BF (Phoenix-definition) and CE (BF/MRI+/biopsies+/local or systemic treatment/metastases+/prostate cancer specific mortality+). Internal validation was performed using bootstrap resampling (500 datasets) after which C-statistic and hazard ratios were adjusted. Models were calibrated and risk scores created. RESULTS: Median follow-up was 35 months (interquartile range: 22-52). Median biochemical disease-free survival (DFS) was 33 months (95% CI: 23-45). Median CE-free survival was 24 months (95% CI: 21-35). After multivariable analysis, DFS interval after primary radiotherapy, presalvage prostate-specific antigen (PSA), PSA-doubling time, prostatic volume, and T-stage (both MRI based) predicted BF. For the CE, PSA-doubling time was not predictive but additionally, primary Gleason score was. The adjusted C-statistics were 0.68 and 0.64 for BF and CE, respectively. Calibration was accurate until 48 months. The risk scores showed 3 groups, with biochemical DFS of 60%, 35%, and 7% and CE-free survival of 40%, 24%, and 0% at 4 years. CONCLUSION: Our model, once externally validated, could allow for better selection of patients for focal salvage HIFU.
Publication Date: 18-Sep-2017
Date of Acceptance: 22-Aug-2017
URI: http://hdl.handle.net/10044/1/51712
DOI: https://dx.doi.org/10.1016/j.urolonc.2017.08.022
ISSN: 1078-1439
Publisher: Elsevier
Start Page: 13.e1
End Page: 13.e10
Journal / Book Title: Urologic Oncology: Seminars and Original Investigations
Volume: 36
Issue: 1
Copyright Statement: © 2017, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: Wellcome Trust
Funder's Grant Number: 204998/Z/16/Z
Keywords: Biochemical failure
Composite endpoint
Focal salvage high intensity focused ultrasound (HIFU)
Prediction models
Prostate cancer
Biochemical failure
Composite endpoint
Focal salvage high intensity focused ultrasound (HIFU)
Prediction models
Prostate cancer
1112 Oncology And Carcinogenesis
Urology & Nephrology
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine



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