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Biomedical subjects

Peter T Scardino

Publications and source records attributed to Peter T Scardino.

At least 19 recordsLinked to original sources
PubMed2003

Detection of clinically significant, occult prostate cancer metastases in lymph nodes using a splice variant-specific rt-PCR assay for human glandular kallikrein.

PURPOSE: To compare the detection of human glandular kallikrein 2 (hK2) mRNA expression in archival lymph nodes with disease progression, the development of prostate cancer metastases, and mortality in patients undergoing radical prostatectomy for locally advanced nonmetastatic prostate cancer. PATIENTS AND METHODS: We evaluated total RNA extracted from fixed, paraffin-embedded, histopathologically normal pelvic lymph nodes, removed at radical prostatectomy, from 199 pT3N0 prostate cancer patients (150 extraprostatic extension only; 49 seminal vesicle involvement) for hK2-expressing cells using a novel reverse transcriptase polymerase chain reaction (RT-PCR)/hK2 assay. Cumulative incidence functions and Cox proportional hazards analyses were performed. RESULTS: Forty patients (20%) had positive results, 80 patients (40%) had negative results, and 79 patients (40%) had equivocal results. RT-PCR/hK2 status was not associated with any pathologic characteristics (P >.05). In postoperative multivariable models, the RT-PCR/hK2 result was associated with prostate cancer progression (P =.001), development of distant metastases (P =.001), and prostate cancer-specific survival (P =.005). In patients experiencing biochemical progression (n = 33), RT-PCR/hK2 status was a predictor of failure to respond to salvage radiotherapy (P =.002). CONCLUSION: RT-PCR/hK2 can detect biologically and clinically significant occult prostate cancer metastases in histopathologically normal lymph nodes. In patients with locally advanced prostate cancer, RT-PCR/hK2 is strongly associated with prostate cancer progression, failure following salvage radiation therapy, development of clinically evident metastases, and prostate cancer-specific mortality after surgery.

Aged↗
PubMed2003

The role of human glandular kallikrein 2 for prediction of pathologically organ confined prostate cancer.

BACKGROUND: In recent studies serum levels of human glandular kallikrein 2 (hK2) demonstrated significant differences in pathologically organ-confined versus non-organ-confined prostate cancer (PCa). In this study we investigated whether hK2 adds independent information when considered together with traditionally used parameters to predict organ confined (pT2a/b) PCa. METHODS: Serum levels of hK2, total and free prostate-specific antigens (PSA) were obtained one day before radical prostatectomy in 245 consecutive men. These were included with clinical stage and biopsy Gleason grade into univariate analysis and multivariate logistic regression models. RESULTS: pT2a/b PCa was found in n = 148 patients. In univariate analysis all preoperative parameters demonstrated significant association with the presence of pT2a/b PCa. Using multivariate logistic regression model hK2 (P = 0.022), clinical stage (P < 0.0001), and Gleason grade (P < 0.0001) were independent predictors of pT2a/b PCa whereas PSA (P = 0.3) was not. In bootstrap corrected logistic regression based nomograms the addition of hK2 density marginally enhanced predictive accuracy when PSA, PSA density, clinical stage, and Gleason grade were considered (AUC = 0.879 without hK2 density and 0.883 with hK2 density). CONCLUSIONS: hK2 and hK2 density could independently predict pT2a/b PCa. However, improvement in predictive accuracy was marginal when nomograms based on traditional variables were complemented with this serum marker.

Area Under Curve↗
PubMed2003

Cross-cultural validation of the UCLA prostate cancer index.

OBJECTIVES: To explore the impact of cross-cultural differences on University of California, Los Angeles, Prostate Cancer Index (PCI) reliability and validity, which is unknown. The PCI represents the most widely used prostate cancer-specific health-related quality-of-life assessment tool. METHODS: The PCI sexual and urinary scales, the RAND SF-36 survey, and the Prostate Outcomes Research Team (PORT) prostate cancer treatment complication profile were self-administered. The principal sample consisted of 2415 men (anglophone 256, francophone 2159) treated with radical prostatectomy in Quebec between 1988 and 1996. An additional 35 men (anglophone 17, francophone 18) formed the retest sample. RESULTS: The PCI demonstrated excellent internal consistency and test-retest reliability in tests based on the entire cohort and in tests addressing the two linguistically different groups. The instrument showed a lack of convergence with the SF-36 scales, confirming the distinctness of the generic and prostate cancer-specific constructs. The PCI sexual scales converged with the aggregate PORT sexual items (r = 0.8), and the PCI urinary scales were strongly related to the aggregate PORT urinary items (r = 0.7). Convergence between PCI urinary bother and function was strong (r = 0.8), but only moderate convergence was noted between PCI sexual bother and function (r = 0.4). The relation between bother and function in both urinary and sexual domains was weaker in anglophone participants relative to their francophone counterparts. CONCLUSIONS: The PCI is reliable and, at best, only modestly affected by cultural differences when administered to culturally distinct English-speaking men or when translated into French.

Cross-Cultural Comparison↗
PubMed2003

National Comprehensive Cancer Network guidelines for the management of prostate cancer.

Guidelines for the management of prostate cancer issued by the National Comprehensive Cancer Network provide a basis for rational treatment decisions. These guidelines represent consensus recommendations by a panel of experts that are evidence based and are designated according to the degree of consensus within the expert panel. The initial stratification point is the patient's life expectancy (>5 or <5 years). If life expectancy is >5 years, the recommended intervention is based on clinical stage, prostate-specific antigen (PSA) level, and Gleason score, as well as the presence of symptoms. These assessments establish the patient's risk of recurrence after therapy. Specific initial therapies are then recommended according to whether the risk category is low, intermediate, high, or very high. The guidelines also describe the appropriate use of observation ("watchful waiting") versus active intervention in certain patients. After definitive therapy, patients should be monitored with PSA determinations, digital rectal examination, and bone scans, as outlined in the guidelines. Patients who exhibit increasing PSA levels after prostatectomy are candidates for salvage therapy with androgen ablation, radiotherapy, or observation. If PSA levels begin to increase after radiotherapy, surgery may then be an additional option. Systemic salvage therapy generally consists of androgen ablation; the benefit of total androgen blockade versus initial monotherapy remains controversial. Relapse after initial androgen ablation is treated with an antiandrogen, if none had been administered previously. Patients refractory to further hormonal manipulations are observed or receive palliative therapy, including chemotherapy. The treatment of prostate cancer is complex. Optimal treatment is risk-adapted to the specific characteristics of the cancer and the expected longevity and personal preferences of the patient.

Androgen Antagonists↗
PubMed2003

Do impalpable stage T1c prostate cancers visible on ultrasound differ from those not visible?

PURPOSE: We assessed whether the appearance of cancer within the prostate on sonography is associated with different pathological features and/or prognoses compared with nonvisible impalpable cancers defined as stage T1c by the TNM staging system. MATERIALS AND METHODS: We analyzed the clinical and pathological features, and progression rate in 323 patients with clinical stage T1cNX M0 cancer treated with radical prostatectomy between 1983 and 1998. Mean followup was 46.8 months (range 1 to 186). RESULTS: Of 323 impalpable stage T1c cancers 170 (53%) were visible and the remainder was not visible on ultrasound. There were no significant differences in clinical or pathological features of the cancers in these 2 groups. The prostate specific antigen nonprogression rate at 5 years was also similar for patients with impalpable cancer regardless of whether the lesion was or was not revealed by ultrasound (mean +/- SE 87% +/- 6% and 91% +/- 6%, respectively, p = 0.3767). Of the 170 visible cancers 55 patients had a hypoechoic lesion considered highly suspicious for cancer. These cancers were higher grade, more extensive, less likely to be confined to the prostate and the prognosis was significantly worse than that of impalpable cancer whether or not they were visible at a less suspicious level (IV or less, p = 0.011). However, such highly suspicious visible cancers are rarely visualized today. Initial serum prostate specific antigen more accurately predicts the pathological stage of impalpable cancer than transrectal ultrasound results. CONCLUSIONS: Impalpable cancers currently detected have similar pathological features and prognoses whether or not they are visible by ultrasound. Therefore, it is reasonable to categorize impalpable cancers as stage T1c and analyze the response to treatment regardless of the results of ultrasound.

Adult↗
PubMed2002

Oncolytic viral gene therapy for prostate cancer using two attenuated, replication-competent, genetically engineered herpes simplex viruses.

BACKGROUND: Attenuated, replication-competent herpes simplex virus mutants offer an exciting new modality in cancer therapy through their ability to selectively replicate within and kill malignant cells with minimal harm to normal tissues. METHODS: This study investigates the efficacy of two such viruses, G207 and NV1020, in human prostatic carcinoma. In vitro studies were performed on four human prostatic carcinoma cell lines, and in vivo single/multiple dose studies were undertaken on mice by using two human cell types. Tumor volume, histopathology at necropsy, and serum prostate specific antigen (PSA) were used as measures of antiproliferative effect in the in vivo experiments. RESULTS: Both viruses were effective in producing cytolytic effects in vitro at various multiplicities of infection in all cell lines tested. Both viruses demonstrated antitumor effects in vivo with a statistically significant decrease in serum PSA and inhibition of growth of both PC-3 and C4-2 subcutaneous xenografts. Tumor-free animals at necropsy were observed in the treated groups but not in control animals. CONCLUSION: These results display impressive activity against human prostate cancer and offer promise for the use of this modality in the future.

Animals↗
PubMed2002

International validation of a preoperative nomogram for prostate cancer recurrence after radical prostatectomy.

PURPOSE: We evaluated the predictive accuracy of a recently published preoperative nomogram for prostate cancer that predicts 5-year freedom from recurrence. We applied this nomogram to patients from seven different institutions spanning three continents. METHODS: Clinical data of 6,754 patients were supplied for validation, and 6,232 complete records were used. Nomogram-predicted probabilities of 60-month freedom from recurrence were compared with actual follow-up in two ways. First, areas under the receiver operating characteristic curves (AUCs) were determined for the entire data set according to several variables, including the institution where treatment was delivered. Second, nomogram classification-based risk quadrants were compared with actual Kaplan-Meier plots. RESULTS: The AUC for all institutions combined was 0.75, with individual institution AUCs ranging from 0.67 to 0.83. Nomogram predictions for each risk quadrant were similar to actual freedom from recurrence rates: predicted probabilities of 87% (low-risk group), 64% (intermediate-low-risk group), 39% (intermediate-high-risk group), and 14% (high-risk group) corresponded to actual rates of 86%, 64%, 42%, and 17%, respectively. The use of neoadjuvant therapy, variation in the prostate-specific antigen recurrence definitions between institutions, and minor differences in the way the Gleason grade was reported did not substantially affect the predictive accuracy of the nomogram. CONCLUSION: The nomogram is accurate when applied at international treatment institutions with similar patient selection and management strategies. Despite the potential for heterogeneity in patient selection and management, most predictions demonstrated high concordance with actual observations. Our results demonstrate that accurate predictions may be expected across different patient populations.

Adult↗
PubMed2002

Analysis of clinical stage T2 prostate cancer: do current subclassifications represent an improvement?

PURPOSE: The purpose of this study was to determine whether the extent of palpable cancer within the prostate predicts outcome after radical prostatectomy. PATIENTS AND METHODS: We combined prospectively collected data on 1,755 consecutive clinical stage T2 patients treated with radical prostatectomy alone at four institutions. According to the 1992 American Joint Committee on Cancer tumor-node-metastasis system, 645 (37%) were T2a, 758 (43%) were T2b, and 352 (20%) were T2c. Kaplan-Meier and proportional hazards regression analyses were performed on the 1992 and 1997 T2 subclassifications. After controlling for the effects of prostate-specific antigen (PSA) and biopsy Gleason sum, the two staging systems were compared for their ability to predict recurrence-free survival (RFS). Adjusted RFS curves were constructed using the corrected group prognosis method. RESULTS: Follow-up ranged from 1 to 166 months (median, 26 months). Cancer recurred in 417 (24%) of the T2 patients. The 1992 (P =.005) but not the 1997 (P =.100) T2 subclassification predicted outcome after controlling for PSA and Gleason sum. After covariate adjustment, RFS was 7% higher at 5 years in the 1992 T2a subcategory relative to the T2b subcategory. CONCLUSION: The 1992 American Joint Committee on Cancer system is superior to the 1997 system, and the former adds prognostic information to a model containing pretreatment PSA and Gleason sum. These results suggest that 1992 T2 subclassification derived from palpable findings improves prognostication over the 1997 subclassification.

Humans↗
PubMed2002

Variations in morbidity after radical prostatectomy.

BACKGROUND: Recent studies of surgery for cancer have demonstrated variations in outcomes among hospitals and among surgeons. We sought to examine variations in morbidity after radical prostatectomy for prostate cancer. METHODS: We used the Surveillance, Epidemiology, and End Results-Medicare linked data base to evaluate health-related outcomes after radical prostatectomy. The rates of postoperative complications, late urinary complications (strictures or fistulas 31 to 365 days after the procedure), and long-term incontinence (more than 1 year after the procedure) were inferred from the Medicare claims records of 11,522 patients who underwent prostatectomy between 1992 and 1996. These rates were analyzed in relation to hospital volume and surgeon volume (the number of procedures performed at individual hospitals and by individual surgeons, respectively). RESULTS: Neither hospital volume nor surgeon volume was significantly associated with surgery-related death. Significant trends in the relation between volume and outcome were observed with respect to postoperative complications and late urinary complications. Postoperative morbidity was lower in very-high-volume hospitals than in low-volume hospitals (27 percent vs. 32 percent, P=0.03) and was also lower when the prostatectomy was performed by very-high-volume surgeons than when it was performed by low-volume surgeons (26 percent vs. 32 percent, P<0.001). The rates of late urinary complications followed a similar pattern. Results for long-term preservation of continence were less clear-cut. In a detailed analysis of the 159 surgeons who had a high or very high volume of procedures, wide surgeon-to-surgeon variations in these clinical outcomes were observed, and they were much greater than would be predicted on the basis of chance or observed variations in the case mix. CONCLUSIONS: In men undergoing prostatectomy, the rates of postoperative and late urinary complications are significantly reduced if the procedure is performed in a high-volume hospital and by a surgeon who performs a high number of such procedures.

Aged↗
PubMed2002

Validation study of the accuracy of a postoperative nomogram for recurrence after radical prostatectomy for localized prostate cancer.

PURPOSE: A postoperative nomogram for prostate cancer was developed at Baylor College of Medicine. This nomogram uses readily available clinical and pathologic variables to predict 7-year freedom from recurrence after radical prostatectomy. We evaluated the predictive accuracy of the nomogram when applied to patients of four international institutions. PATIENTS AND METHODS: Clinical and pathologic data of 2,908 patients were supplied for validation, and 2,465 complete records were used. Nomogram-predicted probabilities of 7-year freedom from recurrence were compared with actual follow-up in two ways. First, the area under the receiver operating characteristic curve (AUC) was calculated for all patients and stratified by the time period of surgery. Second, calibration of the nomogram was achieved by comparing the predicted freedom from recurrence with that of an ideal nomogram. For patients in whom the pathologic report does not distinguish between focal and established extracapsular extension (an input variable of the nomogram), two separate calculations were performed assuming one or the other. RESULTS: The overall AUC was 0.80 when applied to the validation data set, with individual institution AUCs ranging from 0.77 to 0.82. The predictive accuracy of the nomogram was apparently higher in patients who were operated on between 1997 and 2000 (AUC, 0.83) compared with those treated between 1987 and 1996 (AUC, 0.78). Nomogram predictions of 7-year freedom from recurrence were within 10% of an ideal nomogram. CONCLUSION: The postoperative Baylor nomogram was accurate when applied at international treatment institutions. Our results suggest that accurate predictions may be expected when using this nomogram across different patient populations.

Adult↗
PubMed2002

Cancer control with radical prostatectomy alone in 1,000 consecutive patients.

PURPOSE: We analyzed the long-term progression-free probability after radical retropubic prostatectomy in a consecutive series of patients with localized prostate cancer. MATERIALS AND METHODS: From 1983 to 1998, 1,000 patients (median age 62.9 years, range 37.7 to 81.4) with clinical stage T1 to T2 prostate cancer were treated with radical retropubic prostatectomy and pelvic lymphadenectomy, without other cancer related therapy before recurrence. Mean followup was 53.2 months (median 46.9, range 1 to 170). RESULTS: Ten years after radical retropubic prostatectomy the mean probability +/- 2 standard errors that patients remained free of progression and of any further treatment was 75.0% +/- 3.7% and of metastasis 84.2% +/- 4.4%. Mean actuarial cancer specific survival rate +/- 2 standard error was 97.6% +/- 1.7%. In a multivariate analysis pretreatment prostate specific antigen level (p <0.0001), biopsy Gleason sum (p <0.0001) and clinical stage (p=0.0071) were independent prognostic factors for progression. After prostatectomy independent risk factors were Gleason sum in the prostatectomy specimen (p=0.0008), extracapsular extension (p=0.0019), seminal vesical involvement (p <0.0001), lymph node metastasis (p <0.0001) and surgical margin status (p <0.0001). Margins were positive in 12.8% of cases. At 10 years postoperatively radical retropubic prostatectomy was effective for cancer confined to the prostate (92.2% progression-free probability) and also not confined (52.8%), including 71.4% progression-free probability for patients with only extracapsular extension and 37.4% with seminal vesicle invasion without lymph node metastasis. CONCLUSIONS: Radical retropubic prostatectomy provided long-term cancer control in 75% of patients with clinically localized prostate cancer and was effective in the majority of those with high risk cancer, including T2c or biopsy Gleason sum 8 to 10, or PSA greater than 20 ng./ml. Further research should address identifying patients who can safely avoid aggressive therapy.

Adult↗
PubMed2002

Bladder neck involvement in pathological stage pT4 radical prostatectomy specimens is not an independent prognostic factor.

PURPOSE: Bladder neck invasion by prostate cancer in radical prostatectomy specimens is uncommon and, thus, its influence on disease recurrence has not been well defined. Consequently the classification of bladder neck invasion in the TNM staging system is controversial. We studied our cohort of patients with stage pT4 disease and bladder neck invasion to clarify the true clinical behavior and prognostic significance of bladder neck invasion in radical prostatectomy specimens. MATERIALS AND METHODS: The study group consisted of 4,090 consecutive patients treated with radical prostatectomy at one of our institutions between 1983 and 2001. Median followup was 53.1 months (range 1 to 189). After excluding from analysis patients treated with neoadjuvant androgen withdrawal or preoperative irradiation 72 of the remaining 2,571 (2.8%) with bladder neck invasion were classified with stage pT4 disease and their specimens were reviewed. Progression-free probability was determined by Kaplan-Meier analysis. Using the Cox proportional hazards model the independent prognostic significance of bladder neck invasion was assessed after controlling for pretreatment prostate specific antigen, final Gleason sum, extracapsular extension, surgical margins status, seminal vesicle invasion and lymph node involvement. RESULTS: Of the 72 patients categorized with stage pT4 disease 14 (19%) had poorly differentiated Gleason sum 8 to 10 cancer, 38 (53%) had established extracapsular extension, 24 (33%) had seminal vesicle invasion and 8 (11%) had lymph node involvement. However, 26 patients (36%) had cancer confined to the prostate and 28 (39%) had negative surgical margins except for the bladder neck site. The mean 5-year progression-free probability plus or minus SD in all stage pT4 cases was 68% +/- 7%, which was better than in cases of seminal vesicle invasion (52% +/- 5%, log rank test p = 0.0156) but worse than in those of extracapsular extension (84% +/- 4.1%). Univariate analysis of the stage pT4 cohort revealed that higher prostatectomy Gleason sum, more extensive extracapsular extension and seminal vesicle invasion were significantly associated with an adverse prognosis. However, in a multivariate model that included all radical prostatectomy cases the finding of bladder neck invasion or stage pT4 disease did not independently predict prostate specific antigen recurrence. CONCLUSIONS: Stage pT4 disease comprises a heterogeneous group of tumors with various pathological features and inconsistent outcomes. Assigning the pT4 stage to cases of microscopic bladder neck invasion provides no independent ability for predicting disease progression after adjusting for other adverse disease features. Due to this and previously reported data the definition of stage pT4 disease should be modified in the next version of the TNM staging system.

Adult↗
PubMed2002

Urinary continence after radical retropubic prostatectomy: relationship with membranous urethral length on preoperative endorectal magnetic resonance imaging.

PURPOSE: We determined whether membranous urethral length on preoperative magnetic resonance imaging (MRI) is predictive of urinary continence after radical retropubic prostatectomy. MATERIALS AND METHODS: Membranous urethral length was measured on preoperative endorectal MRI in 211 consecutive patients with newly diagnosed prostate cancer before radical retropubic prostatectomy performed by a single surgeon. Neurovascular bundle resection was done in 60 cases. After surgery the time to stable postoperative continence was recorded in 180 cases and the level of stable continence was graded on a 5-point scale of 1-complete continence to 5-complete incontinence. RESULTS: After controlling for age and surgical technique multivariate analysis showed that membranous urethral length was related to time to stable postoperative continence (p = 0.02), such that a longer membranous urethra was associated with a shorter time to stable continence. For example, 1 year after surgery 120 of the 134 patients (89%) with a preoperative membranous urethral length of greater than 12 mm. were completely continent compared with 35 of the 46 (77%) with a preoperative length of 12 mm. or less. CONCLUSIONS: On endorectal MRI before radical prostatectomy a longer membranous urethra is associated with significantly more rapid return of urinary continence after surgery.

Adult↗
PubMed2002

Blood loss during radical retropubic prostatectomy: relationship to morphologic features on preoperative endorectal magnetic resonance imaging.

OBJECTIVES: To determine whether morphologic features at preoperative magnetic resonance imaging (MRI) are related to intraoperative blood loss during radical retropubic prostatectomy. METHODS: Endorectal MRI was performed in 143 patients with newly diagnosed prostate cancer before radical retropubic prostatectomy. Two independent readers rated the prominence of the periprostatic veins (on the basis of number and size) at four anatomic sites on a 3-point scale. Other features analyzed were prostate volume and interspinous diameter. RESULTS: A prominence of the anterior and posterior apical periprostatic veins was positively associated with blood loss (correlation coefficient = 0.22 and 0.17 and P <0.01 and <0.05, respectively). Blood loss was not related to prostate volume (correlation coefficient = 0.02, P = 0.8) or interspinous diameter (correlation coefficient = 0.01, P = 0.9). The site-specific scores of both readers demonstrated positive agreement, with Pearson's correlation coefficients of 0.51 to 0.65 (P <0.01). CONCLUSIONS: A marked prominence of the apical periprostatic veins on preoperative MRI is associated with greater intraoperative blood loss during radical retropubic prostatectomy. Other morphologic factors appear unrelated to the amount of intraoperative blood loss.

Adult↗
PubMed2002

Prostate biopsy techniques and indications: when, where, and how?

Transrectal ultrasound (TRUS) and prostate biopsy have become one of the most common office-based procedures for the practicing urologist. During the past 50 years, the techniques, indications, and pathologic interpretation of prostate biopsies have evolved. The abandonment of blind finger-guided needle biopsies in favor of systematic TRUS-guided biopsies epitomizes much of this change. Similarly, the indications for prostate biopsy have become more refined. In the past, the presence of a prostatic nodule on digital rectal examination (DRE) was the primary indication for biopsy until the introduction of prostatic-specific antigen (PSA) in the 1980s and its widespread use for prostate cancer screening. Abnormalities of PSA or its derivatives now represent the most common indication for prostate biopsy. Although TRUS initially began as a tool to direct needles into various locations within the prostate, today a great deal of information can be obtained from prostate ultrasound for the discerning clinician. As such, TRUS-guided biopsy of the prostate has become an important staging and diagnostic tool for the practicing urologist. Here we review the current techniques and indications as well as pertinent pathologic and staging data obtained through TRUS and prostate biopsy.

Algorithms↗
PubMed2002

Comparisons of nomograms and urologists' predictions in prostate cancer.

When applying nomograms to a clinical setting it is essential to know how their predictions compare with clinicians'. Comparisons exist outside of the prostate cancer literature. We reviewed these comparisons and conducted 2 experiments comparing predictions of clinicians with prostate cancer nomograms. By using Medline, we searched studies from January 1966 to July 1999 that compared human predictions with nomogram predictions. Next, we conducted 2 experiments: (1) 17 urologists were presented with 10 case vignettes and asked to predict the 5-year recurrence-free probabilities for each patient; (2) case presentations of 63 prostate cancer patients (including full clinical histories with complete diagnostic data and surgical findings) were made to a group of 25 clinicians who were asked to predict organ-confined disease. We found 22 published studies comparing human experts with nomograms, greater than half (13 of 22) showed the nomogram performing above the level of the human expert. Our first experiment showed urologist modification of 165 nomogram predictions led to a decrease in prediction accuracy (c-index decreased from.67 to.55, P <.05). In our second experiment, clinician predictions of organ-confined disease were comparable to the nomogram (area under the receiver operating characteristic curve [AUC] 0.78 and 0.79, respectively). A mixed-model suggests the nomogram did not augment clinician prediction accuracy (doctor excess error 1.4%, P =.75, 95% confidence interval [CI]: -10.9% to 8.2%). Our data suggest that nomograms do not seem to diminish predictive accuracy and they may be of significant benefit in certain clinical decision making settings.

Carcinoma↗
PubMed2002

Nomograms as predictive models.

Nomograms are valuable tools for estimating the likelihood of cancer being diagnosed, the pathologic features of a localized cancer, and the prognosis of a patient after treatment. Although the available nomograms are reasonably accurate, better predictive factors including additional clinical factors and new molecular analyses are needed to improve the accuracy or predictions. Nomogram performance will also be enhanced with larger datasets of patients and longer follow-up. We review the concepts of risk stratification and the development and use of nomograms as predictive tools.

Expert Systems↗