title: Validation and comparison of the two Kattan nomograms in patients with prostate cancer treated with (125) iodine brachytherapy.
abstract: Study Type - Prognostic (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Nomograms are based on large patient population. Their applicability should be externally validated. Among 747 brachytherapy patients we evaluated two Kattan nonograms and conclude that they have limited value to predict PSA-free survival.
  
  
  OBJECTIVE
  To validate and compare the preoperative and postoperative Kattan prediction nonograms for prostate cancer recurrence after brachytherapy.
  
  
  METHODS
  Patients (n= 747) treated with (125) I-brachytherapy were evaluated. Both nomograms were used to calculate the prediction of 5-year biochemical-freedom from failure (BFFF) based on clinical stage, Gleason score, prostate-specific antigen (PSA) level, receipt of androgen deprivation therapy and the post-implant dosimetry variable D90 (values of the minimal dose received by 90% of the prostate volume). The predicted values using the Kattan nomograms and the observed values were compared. Predictive accuracy was determined using the concordance index.
  
  
  RESULTS
  The 5-year BFFF probability was 94% (95% confidence interval [CI], 92-96%) for the modified American Society for Radiation Oncology (ASTRO) definition and 97% (95% CI, 95-98%) for the Phoenix definition using Kaplan-Meier analysis. The predicted values of BFFF using both Kattan nomograms were lower than the observed rates in our cohort. The concordance index values were 0.51 and 0.52 for preoperative and postoperative nomograms, respectively. Concordance correlation coefficient between the two nomograms was 0.15.
  
  
  CONCLUSIONS
  In our population, the 5-year BFFF outcomes rates were superior to nomogram predictions. Neither nomogram predicted outcomes after (125) I-brachytherapy in this non-US cohort. The postoperative nomogram was also a poor predictor, although it included D90 dosimetry values, as a variable of treatment quality. Strict inclusion criteria, perhaps more favourable than the ones on which the Kattan nomograms were based, could be the explanation for these discrepancies.
authors: Tel Aviv University, Tel Aviv Israel Center for Disease Control, Sheba Medical Center, Tel Hashomer, Israel.
authors: Alan
authors: A
authors: Kaplan
authors: Larissa
authors: L
authors: German
authors: Juza
authors: J
authors: Chen
authors: Haim
authors: H
authors: Matzkin
authors: Nicola J
authors: NJ
authors: Mabjeesh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes