The online version of this article (doi:10.1186/s13014-017-0786-z) contains supplementary material, which is available to authorized users.
Prostate cancer can be treated with several different modalities, including radiation treatment. Various prognostic tools have been developed to aid decision making by providing estimates of the probability of different outcomes. Such tools have been demonstrated to have better prognostic accuracy than clinical judgment alone.
A systematic review was undertaken to identify papers relating to the prediction of clinical outcomes (biochemical failure, metastasis, survival) in patients with prostate cancer who received radiation treatment, with the particular aim of identifying whether published tools are adequately developed, validated, and provide accurate predictions. PubMed and EMBASE were searched from July 2007. Title and abstract screening, full text review, and critical appraisal were conducted by two reviewers. A review protocol was published in advance of commencing literature searches.
The search strategy resulted in 165 potential articles, of which 72 were selected for full text review and 47 ultimately included. These papers described 66 models which were newly developed and 31 which were external validations of already published predictive tools. The included studies represented a total of 60,457 patients, recruited between 1984 and 2009. Sixty five percent of models were not externally validated, 57% did not report accuracy and 31% included variables which are not readily accessible in existing datasets. Most models (72, 74%) related to external beam radiation therapy with the remainder relating to brachytherapy (alone or in combination with external beam radiation therapy).
A large number of prognostic models (97) have been described in the recent literature, representing a rapid increase since previous reviews (17 papers, 1966–2007). Most models described were not validated and a third utilised variables which are not readily accessible in existing data collections. Where validation had occurred, it was often limited to data taken from single institutes in the US. While validated and accurate models are available to predict prostate cancer specific mortality following external beam radiation therapy, there is a scarcity of such tools relating to brachytherapy. This review provides an accessible catalogue of predictive tools for current use and which should be prioritised for future validation.
Additional file 1: Reasons for exclusion from the review. (DOCX 21 kb)13014_2017_786_MOESM1_ESM.docx
Global Burden of Disease Cancer C, Fitzmaurice C, Dicker D, et al. The global burden of cancer 2013. JAMA. 2015;1:505–27.
Medicine CfE-B. Critical appraisal of Prognostic studies. 2016 [cited 2016]; Available from: http://www.cebm.net/critical-appraisal/
Yoshida K, Yamazaki H, Nakamura S, et al. Role of novel risk classification method, Prostate Cancer Risk Index (PRIX) for clinically localized prostate cancer after high-dose-rate interstitial brachytherapy as monotherapy. Anticancer Res. 2014;34:3077–81. PubMed
Vainshtein JM, Schipper M, Vance S, Feng FY, Olson KB, Hamstra DA. Limitations of the cancer of the prostate risk assessment (CAPRA) prognostic tool for prediction of metastases and prostate cancer-specific mortality in patients treated with external beam radiation therapy. Cancer Clinical Trials: American Journal of Clinical Oncology; 2014.
Krishnan V, Delouya G, Bahary JP, Larrivee S, Taussky D. The Cancer of the Prostate Risk Assessment (CAPRA) score predicts biochemical recurrence in intermediate-risk prostate cancer treated with external beam radiotherapy (EBRT) dose escalation or low-dose rate (LDR) brachytherapy. BJU Int. 2014;114:865–71. CrossRefPubMed
Vainshtein JM, Schipper M, Vance S, Feng FY, Olson KB, Hamstra DA. Limitations of the Cancer of the Prostate Risk Assessment (CAPRA) Prognostic Tool for Prediction of Metastases and Prostate Cancer-specific Mortality in Patients Treated With External Beam Radiation Therapy. Am J Clin Oncol. 2014
S. HDWaL. Applied logistic regression. 2nd ed. New York: Wiley; 2000.
Hall WA, Lawton CA, Jani AB, Pollack A, Feng FY. Biomarkers of outcome in patients with localized prostate cancer treated with radiotherapy. Seminars in radiation oncology: Elsevier; 2017. p. 11–20.
Cooperberg MR, Vickers AJ, Broering JM, Carroll PR. Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010;116(22):5226–34. Pubmed Central PMCID: PMC2975879, Epub 2010/08/07. eng. CrossRefPubMedPubMedCentral
Denham JW, Steigler A, Wilcox C, Lamb DS, Joseph D, Atkinson C, et al. Time to biochemical failure and prostate-specific antigen doubling time as surrogates for prostate cancer-specific mortality: evidence from the TROG 96.01 randomised controlled trial. Lancet Oncol. 2008;9(11):1058–68. CrossRefPubMed
Murgic J, Stenmark MH, Halverson S, Blas K, Feng FY, Hamstra DA. The role of the maximum involvement of biopsy core in predicting outcome for patients treated with dose-escalated radiation therapy for prostate cancer. Radiation oncology (London, England). 2012;7:127. Pubmed Central PMCID: 3484035.
Proust-Lima C, Taylor JM. Development and validation of a dynamic prognostic tool for prostate cancer recurrence using repeated measures of posttreatment PSA: a joint modeling approach. Biostatistics (Oxford, England). 2009;10(3):535-49. Pubmed Central PMCID: PMC2697347. Epub 2009/04/17. eng.
Sabolch A, Feng FY, Daignault-Newton S, Halverson S, Blas K, Phelps L, et al. Gleason Pattern 5 is the greatest risk factor for clinical failure and death from prostate cancer after dose-escalated radiation therapy and hormonal ablation. Int J Radiat Oncol Biol Phys. 2011;81(4):e351–60. CrossRefPubMed
Slater JM, Bush DA, Grove R, Slater JD. The prognostic value of percentage of positive biopsy cores, percentage of cancer volume, and maximum involvement of biopsy cores in prostate cancer patients receiving proton and photon beam therapy. Technol Cancer Res Treat. 2014;13(3):227–31. PubMed
Steigler A, Denham JW, Lamb DS, Spry NA, Joseph D, Matthews J, et al. Risk stratification after biochemical failure following curative treatment of locally advanced prostate cancer: Data from the TROG 96.01 trial. Prostate cancer. 2012.
Sylvester JE, Grimm PD, Wong J, Galbreath RW, Merrick G, Blasko JC. Fifteen-year biochemical relapse-free survival, cause-specific survival, and overall survival following I(125) prostate brachytherapy in clinically localized prostate cancer: Seattle experience. Int J Radiat Oncol Biol Phys. 2011;81(2):376–81. CrossRefPubMed
Thames HD, Kuban D, Levy LB, Horwitz EM, Kupelian P, Martinez A, et al. The role of overall treatment time in the outcome of radiotherapy of prostate cancer: an analysis of biochemical failure in 4839 men treated between 1987 and 1995. Radiother Oncol. 2010;96(1):6–12. Epub 2010/04/20. eng. CrossRefPubMed
Vance SM, Stenmark MH, Blas K, Halverson S, Hamstra DA, Feng FY. Percentage of cancer volume in biopsy cores is prognostic for prostate cancer death and overall survival in patients treated with doseescalated external beam radiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(3):940–6. Epub 2011/11/08. eng. CrossRefPubMed
Westphalen AC, Koff WJ, Coakley FV, Muglia VF, Neuhaus JM, Marcus RT, et al. Prostate cancer: Prediction of biochemical failure after external-beam radiation therapy - Kattan nomogram and endorectal MR imaging estimation of tumor volume. Radiology. 2011;261(2):477–86. English. CrossRefPubMedPubMedCentral
Yu M, Taylor JMG, Sandler HM. Individual Prediction in Prostate Cancer Studies using a Joint Longitudinal Survival-Cure Model. J Am Stat Assoc. 2008;103(481):178–87. CrossRef
Zaorsky NG, Li T, Devarajan K, Horwitz EM, Buyyounouski MK. Assessment of the American Joint Committee on Cancer staging (sixth and seventh editions) for clinically localized prostate cancer treated with external beam radiotherapy and comparison with the National Comprehensive Cancer Network riskstratification method. Cancer. 2012;118(22):5535–43. Pubmed Central PMCID: PMC3410044, Epub 2012/05/01. eng. CrossRefPubMedPubMedCentral
- An appraisal of analytical tools used in predicting clinical outcomes following radiation therapy treatment of men with prostate cancer: a systematic review
Michael E. O’Callaghan
Andrew D. Vincent
- BioMed Central
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