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Anderson AB, Grazal C, Wedin R, Kuo C, Chen Y, Christensen BR, Cullen J, Forsberg JA. Machine learning algorithms to estimate 10-Year survival in patients with bone metastases due to prostate cancer: toward a disease-specific survival estimation tool. BMC Cancer 2022; 22:476. [PMID: 35490227 PMCID: PMC9055684 DOI: 10.1186/s12885-022-09491-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Prognostic indicators, treatments, and survival estimates vary by cancer type. Therefore, disease-specific models are needed to estimate patient survival. Our primary aim was to develop models to estimate survival duration after treatment for skeletal-related events (SREs) (symptomatic bone metastasis, including impending or actual pathologic fractures) in men with metastatic bone disease due to prostate cancer. Such disease-specific models could be added to the PATHFx clinical-decision support tool, which is available worldwide, free of charge. Our secondary aim was to determine disease-specific factors that should be included in an international cancer registry. Methods We analyzed records of 438 men with metastatic prostate cancer who sustained SREs that required treatment with radiotherapy or surgery from 1989–2017. We developed and validated 6 models for 1-, 2-, 3-, 4-, 5-, and 10-year survival after treatment. Model performance was evaluated using calibration analysis, Brier scores, area under the receiver operator characteristic curve (AUC), and decision curve analysis to determine the models’ clinical utility. We characterized the magnitude and direction of model features. Results The models exhibited acceptable calibration, accuracy (Brier scores < 0.20), and classification ability (AUCs > 0.73). Decision curve analysis determined that all 6 models were suitable for clinical use. The order of feature importance was distinct for each model. In all models, 3 factors were positively associated with survival duration: younger age at metastasis diagnosis, proximal prostate-specific antigen (PSA) < 10 ng/mL, and slow-rising alkaline phosphatase velocity (APV). Conclusions We developed models that estimate survival duration in patients with metastatic bone disease due to prostate cancer. These models require external validation but should meanwhile be included in the PATHFx tool. PSA and APV data should be recorded in an international cancer registry.
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Affiliation(s)
- Ashley B Anderson
- Division of Orthopaedics, Department of Surgery, Uniformed Services University, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA
| | - Clare Grazal
- The Henry Jackson Foundation for the Advancement of Sciences, 6720A Rockledge Dr, Suite 100, Bethesda, MD, 20817, USA
| | - Rikard Wedin
- Department of Molecular Medicine and Surgery (MMK), K1, Orthopaedics, Karolinska, Institutet, A2:07 171 76, Stockholm, Sweden
| | - Claire Kuo
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University, Walter Reed National Military Medical Center, 6720A Rockledge Dr, Suite 300, Bethesda, MD, 20817, USA
| | - Yongmei Chen
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University, Walter Reed National Military Medical Center, 6720A Rockledge Dr, Suite 300, Bethesda, MD, 20817, USA
| | - Bryce R Christensen
- Department of Internal Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Dr, San Antonio, TX, 78219, USA
| | - Jennifer Cullen
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Wolstein Research Building 2520, 2103 Cornell Road, Cleveland, OH, 44106, USA
| | - Jonathan A Forsberg
- Division of Orthopaedics, Department of Surgery, Uniformed Services University, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA. .,Department of Orthopaedic Surgery, The Johns Hopkins University Hospital, 601 N. Caroline St, Baltimore, MD, 21287, USA.
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Brand DH, Parker JI, Dearnaley DP, Eeles R, Huddart R, Khoo V, Murray J, Suh YE, Tree AC, van As N, Parker C. Patterns of recurrence after prostate bed radiotherapy. Radiother Oncol 2019; 141:174-180. [PMID: 31563410 DOI: 10.1016/j.radonc.2019.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Prostate bed radiotherapy is a standard treatment after radical prostatectomy. Recent evidence suggests that, for patients with a PSA > 0.34 ng/ml, the radiotherapy treatment volume should include not only the prostate bed but also the pelvic lymph nodes. We describe the patterns of failure after prostate bed radiotherapy, focussing on the proportion of patients with radiologically confirmed pelvic nodal failure only, in the absence of distant disease. MATERIALS AND METHODS Patients included were men receiving prostate bed radiotherapy at the Royal Marsden Hospital between 1997 and 2013. The key outcome of interest was the pattern of radiologic failure after prostate bed radiotherapy. Baseline characteristics of patients experiencing pelvic nodal failure without distant disease were compared versus all other relapse patterns. Comparisons were by Chi-square test, with multiple testing adjusted p < 0.005 significant. RESULTS 140 of 322 patients developed biochemical failure after salvage RT. Radiologic failure occurred in 89 patients. 35 of the 89 patients (39%) with radiologic failure had pelvic nodal failure without distant disease, with no significant differences in baseline characteristics when compared to all other patients. The rate of pelvic nodal failure was the same for patients with PSA above or below 0.34 ng/ml (16/149, 95% CI = 6-17% vs 19/171, 95% CI = 7-17%). CONCLUSIONS Pelvic lymph node disease, without more distant disease, is a common site of failure in men receiving radiotherapy to the prostate bed, including those with PSA < 0.34 ng/ml. This observation informs the case for including the pelvic lymph nodes in the radiotherapy treatment volume.
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Affiliation(s)
- Douglas H Brand
- Urological Oncology Department, Royal Marsden Hospital, London & Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London & Sutton, UK
| | - Joanna I Parker
- Radiotherapy and Imaging Division, Institute of Cancer Research, London & Sutton, UK
| | - David P Dearnaley
- Urological Oncology Department, Royal Marsden Hospital, London & Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London & Sutton, UK
| | - Rosalind Eeles
- Urological Oncology Department, Royal Marsden Hospital, London & Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London & Sutton, UK
| | - Robert Huddart
- Urological Oncology Department, Royal Marsden Hospital, London & Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London & Sutton, UK
| | - Vincent Khoo
- Urological Oncology Department, Royal Marsden Hospital, London & Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London & Sutton, UK
| | - Julia Murray
- Urological Oncology Department, Royal Marsden Hospital, London & Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London & Sutton, UK
| | - Yae-Eun Suh
- Urological Oncology Department, Royal Marsden Hospital, London & Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London & Sutton, UK
| | - Alison C Tree
- Urological Oncology Department, Royal Marsden Hospital, London & Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London & Sutton, UK
| | - Nicholas van As
- Urological Oncology Department, Royal Marsden Hospital, London & Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London & Sutton, UK
| | - Chris Parker
- Urological Oncology Department, Royal Marsden Hospital, London & Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London & Sutton, UK.
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