Development and Validation of Nomograms Based on Nutritional Risk Index for Predicting Extracapsular Extension and Seminal Vesicle Invasion in Patients Undergoing Radical Prostatectomy.

IF 2.1 Q3 ONCOLOGY World Journal of Oncology Pub Date : 2023-12-01 Epub Date: 2023-11-18 DOI:10.14740/wjon1718
Ze Nan Liu, Zi Ang Li, Ji De He, Jia Long Wu, Lei Qiu, Zhen Kun Zhao, Min Lu, Hai Bi, Jian Lu
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Abstract

Background: The aim of the study was to investigate the predictive value of the nutritional risk index (NRI) for extracapsular extension (ECE) and seminal vesicle invasion (SVI) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP), and further develop and validate predictive nomograms for ECE and SVI based on the NRI.

Methods: We retrospectively analyzed 734 PCa patients who underwent RP between 2010 and 2020 in the Department of Urology at Peking University Third Hospital. The enrolled patients were randomly divided into a primary cohort (n = 489) and a validation cohort (n = 245) in a 2:1 manner. The baseline NRI of patients was calculated using serum albumin level and body mass index, and a malnutrition status was defined as NRI ≤ 98. Univariate and multivariate logistic regression analyses were conducted to identify predictors for ECE and SVI. Nomograms for predicting ECE and SVI were established based on the results of the multivariate logistic regression analysis. The performance of the nomograms was estimated using Harrell's concordance index (C-index), the area under curve (AUC) of receiver operating characteristic (ROC) curves and the calibration curves.

Results: In the primary cohort, 70 (14.3%) patients with NRI ≤ 98 were classified as malnutrition, while the remaining 419 (85.7%) patients with NRI > 98 were considered to have normal nutrition. The nomograms for predicting ECE and SVI shared common factors including NRI, percentage of positive biopsy cores (PPC) and biopsy Gleason score, while prostate-specific antigen (PSA) levels and PSA density (PSAD) were only incorporated in ECE nomogram. The C-indexes of the nomograms for predicting ECE and SVI were 0.785 (95% confidence interval (CI): 0.745 - 0.826) and 0.852 (95% CI: 0.806 - 0.898), respectively. The calibration curves demonstrated excellent agreement between the predictions by the nomograms and the actual observations. The results remained reproducible when the nomograms were applied to the validation cohort.

Conclusions: The NRI is significantly associated with ECE and SVI in PCa patients. The nomogram established based on the NRI in our study can provide individualized risk estimation for ECE and SVI in PCa patients, and may be valuable for clinicians in making well-informed decisions regarding treatment strategies and patient management.

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基于营养风险指数的nomogram预测根治性前列腺切除术患者囊外延伸和精囊侵犯的方法的建立和验证。
背景:本研究旨在探讨营养风险指数(NRI)对根治性前列腺切除术(RP)前列腺癌(PCa)患者囊外延伸(ECE)和精囊侵犯(SVI)的预测价值,并进一步开发和验证基于NRI的ECE和SVI预测图。方法:回顾性分析2010年至2020年北京大学第三医院泌尿外科734例行RP手术的PCa患者。纳入的患者按2:1的比例随机分为主要队列(n = 489)和验证队列(n = 245)。采用血清白蛋白水平和体重指数计算患者的基线NRI, NRI≤98定义为营养不良状态。进行单因素和多因素logistic回归分析以确定ECE和SVI的预测因子。根据多变量logistic回归分析结果,建立预测ECE和SVI的nomogram。利用Harrell’s concordance index (C-index)、受试者工作特征曲线(ROC)曲线下面积(AUC)和校准曲线对nomogram的性能进行了评价。结果:在初级队列中,70例(14.3%)NRI≤98的患者为营养不良,其余419例(85.7%)NRI > 98的患者为营养正常。预测ECE和SVI的nomogram有共同的因素,包括NRI、活检阳性核心百分比(PPC)和活检Gleason评分,而前列腺特异性抗原(PSA)水平和PSA密度(PSAD)仅纳入ECE nomogram。预测ECE和SVI的模态图c指数分别为0.785(95%可信区间(CI): 0.745 ~ 0.826)和0.852 (95% CI: 0.806 ~ 0.898)。标定曲线表明,由模态图预测的结果与实际观测结果非常吻合。当nomogram应用于验证队列时,结果仍然是可重复的。结论:PCa患者的NRI与ECE和SVI显著相关。在我们的研究中,基于NRI建立的nomogram可以为PCa患者的ECE和SVI提供个性化的风险评估,并且可能对临床医生在治疗策略和患者管理方面做出明智的决策有价值。
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来源期刊
CiteScore
6.10
自引率
15.40%
发文量
37
期刊介绍: World Journal of Oncology, bimonthly, publishes original contributions describing basic research and clinical investigation of cancer, on the cellular, molecular, prevention, diagnosis, therapy and prognosis aspects. The submissions can be basic research or clinical investigation oriented. This journal welcomes those submissions focused on the clinical trials of new treatment modalities for cancer, and those submissions focused on molecular or cellular research of the oncology pathogenesis. Case reports submitted for consideration of publication should explore either a novel genomic event/description or a new safety signal from an oncolytic agent. The areas of interested manuscripts are these disciplines: tumor immunology and immunotherapy; cancer molecular pharmacology and chemotherapy; drug sensitivity and resistance; cancer epidemiology; clinical trials; cancer pathology; radiobiology and radiation oncology; solid tumor oncology; hematological malignancies; surgical oncology; pediatric oncology; molecular oncology and cancer genes; gene therapy; cancer endocrinology; cancer metastasis; prevention and diagnosis of cancer; other cancer related subjects. The types of manuscripts accepted are original article, review, editorial, short communication, case report, letter to the editor, book review.
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