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Inicio Actas Urológicas Españolas (English Edition) Gleason sum upgrading between biopsy and radical prostatectomy in Chinese popula...
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Vol. 41. Issue 3.
Pages 162-171 (April 2017)
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Vol. 41. Issue 3.
Pages 162-171 (April 2017)
Original article
Gleason sum upgrading between biopsy and radical prostatectomy in Chinese population: Updated nomograms
Infragradación de la biopsia de próstata respecto a la pieza de prostatectomía la población China: nomogramas actualizados
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H. Xua, P.D. Baib, M.B. Hua, S.H. Maoa, W.H. Zhua, J.M. Hua, S.H. Liua, T. Yanga, J.Y. Houa, Y. Hua, Q. Dinga, H.W. Jianga,
Corresponding author
haowen_jiang@126.com

Corresponding author.
a Departamento de Urología, Hospital Huashan, Universidad Fudan, Shanghai, PR China
b Departamento de Urología, The First Affiliated Hospital of Xiamen University, Fujian, PR China
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Table 1. Basic clinical and pathological characteristics of patients.
Table 2. Univariate and multivariate logistic regression models predicting Gleason sum upgrading between biopsy and final pathology.
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Abstract
Introduction

To assess the risk factors of Gleason sum upgrading between biopsy and radical prostatectomy (RP) and update the nomogram for the prediction of Gleason sum upgrading.

Methods

The study cohort consisted of 237 Chinese prostate adenocarcinoma patients who underwent 10-core prostate biopsy and subsequently received RP in Huashan Hospital from February 2011 to May 2015. The main outcome of our study was Gleason sum upgrading between biopsy and RP pathology. Univariate and multivariate logistic regression models were conducted to explore the potential predictors, and ultimately to build the nomograms. The prediction model was further evaluated for its ability to predict significant upgrading in patients with biopsy Gleason sum<8.

Results

In the main cohort of all the patients, Gleason sum upgrading was observed in 62 (26.16%) patients. The pre-operative prostate-specific antigen (PSA) level, biopsy Gleason sum, and digital rectal examination were used in building the nomogram, which was validated internally with a bootstrap-corrected concordance index of 0.787. In the sub-cohort of 115 patients with standardized biopsy details, Gleason sum upgrading was observed in 31 (26.96%) patients. The pre-operative PSA level, biopsy Gleason sum, and number of positive cores were used in the nomogram, which was also validated internally with a bootstrap-corrected concordance index of 0.833. These two nomograms both demonstrated satisfactory statistical performance for predicting significant upgrading.

Conclusions

Updated nomograms to predict Gleason sum upgrading in Chinese population between biopsy and RP were developed, demonstrating good statistical performance upon internal validation.

Keywords:
Biopsy
Gleason score
Nomogram
Prostate adenocarcinoma
Radical prostatectomy
Resumen
Introducción

Evaluar los factores de riesgo de la supragraduación de la suma de Gleason en la prostatectomía radical (PR) y actualizar el nomograma para la predicción de la infragraduación de la biopsia respecto a la pieza de prostatectomía radical.

Métodos

La cohorte del estudio consistió en 237 pacientes chinos con adenocarcinoma de próstata que fueron sometidos a biopsia de próstata de 10 cilindros y posteriormente fueron sometidos PR en el Hospital Huashan, entre febrero de 2011 y mayo de 2015. El principal objetivo de nuestro estudio fue el estudio de la supragraduación de la suma de Gleason respecto a la biopsia en la muestra de PR. Se realizaron modelos de regresión logística univariante y multivariante para explorar los potenciales factores predictivos, y en última instancia para construir los nomogramas. El modelo de predicción se evaluó por su capacidad para predecir la supragraduación significativa en pacientes con suma de Gleason de biopsia <8.

Resultados

En la cohorte principal se observó supragraduación de la suma de Gleason en 62 (26,16%) pacientes. El nivel de antígeno específico de próstata (PSA) preoperatorio, la suma de Gleason de biopsia y el tacto rectal se utilizaron en la construcción del nomograma, que fue validado internamente con un índice de concordancia corregido por bootstrap de 0,787. En la subcohorte de 115 pacientes con datos estandarizados de biopsia se observó supragraduación en 31 (26,96%) pacientes. El nivel preoperatorio de PSA, suma de Gleason de biopsia y el número de cilindros positivos se utilizaron en el nomograma, que también fue validado internamente con un índice de concordancia de corregido por bootstrap de 0,833. Estos 2 nomogramas demostraron un rendimiento estadístico satisfactorio para predecir supragraduación significativa.

Conclusiones

Se desarrollaron nomogramas actualizados para predecir la supragraduación de la suma de Gleason de la biopsia respecto a la PR, que demostraron un buen rendimiento estadístico tras la validación interna.

Palabras clave:
Biopsia
Puntuación de Gleason
Nomograma
Adenocarcinoma de próstata
Prostatectomía radical

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