title: Three linked nomograms for predicting biochemical failure in prostate cancer treated with radiotherapy plus androgen deprivation therapy.
abstract: BACKGROUND
  Nomograms were established to predict biochemical recurrence (BCR) after radiotherapy (RT) with a low weight of the characteristic variables of RT and androgen deprivation therapy (ADT). Our aim is to provide a new stratified tool for predicting BCR at 4 and 7 years in patients treated using RT with radical intent.
  
  
  METHODS
  A retrospective, nonrandomized analysis was performed on 5044 prostate cancer (PCa) patients with median age 70 years, who received RT-with or without ADT-between November 1992 and May 2007. Median follow-up was 5.5 years. BCR was defined as a rise in serum prostate-specific antigen (PSA) of 2 ng/ml over the post-treatment PSA nadir. Univariate association between predictor variables and BCR was assessed by the log-rank test, and three linked nomograms were created for multivariate prognosis of BCR-free survival. Each nomogram corresponds to a category of the Gleason score-either 6,7, or 8-10-and all of them were created from a single proportional hazards regression model stratified also by months of ADT (0, 1-6, 7-12, 13-24, 25-36, 36-60). The performance of this model was analyzed by calibration, discrimination, and clinical utility.
  
  
  RESULTS
  Initial PSA, clinical stage, and RT dose were significant variables (p < 0.01). The model showed a good calibration. The concordance probability was 0.779, improving those obtained with other nomograms (0.587, 0.571, 0.554) in the database. Survival curves showed best clinical utility in a comparison with National Comprehensive Cancer Network (NCCN) risk groups.
  
  
  CONCLUSIONS
  For each Gleason score category, the nomogram provides information on the benefit of adding ADT to a specific RT dose.
authors.affiliation: Servicio Oncología Radioterápica- ERESA, Hospital General Universitario, Avda. Tres Cruces s/n, 46014, Valencia, Spain. jltorrecilla@eresa.com.
authors.forename: Jose
authors.initials: J
authors.lastname: López-Torrecilla
authors.affiliation: S.Oncología Radioterápica, Institut Catala d'Oncologia, Hospitalet, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Boladeras
authors.affiliation: S.Oncología Radioterápica, Hospital Universitario Doce de Octubre, Madrid, Spain.
authors.forename: María Angeles
authors.initials: MA
authors.lastname: Cabeza
authors.affiliation: S.Oncología Radioterápica, Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Almudena
authors.initials: A
authors.lastname: Zapatero
authors.affiliation: S.Oncología Radioterápica, Institut Catala d'Oncologia, Badalona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Jove
authors.affiliation: Escuela Universitaria Politécnica de La Almunia, Universidad de Zaragoza, Zaragoza, Spain.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Esteban
authors.affiliation: S.Oncología Radioterápica, Hospital Universitari Sant Joan de Reus, Reus, Spain.
authors.forename: Ivan
authors.initials: I
authors.lastname: Henriquez
authors.affiliation: S.Oncología Radioterápica, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Casaña
authors.affiliation: S.Oncología Radioterápica, Hospital Universitario Gregorio Marañon, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: González-San Segundo
authors.affiliation: S.Oncología Radioterápica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gómez-Caamaño
authors.affiliation: S.Oncología Radioterápica, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Mengual
authors.affiliation: S.Oncología Radioterápica, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Asunción
authors.initials: A
authors.lastname: Hervás
authors.affiliation: S.Oncología Radioterápica, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Julia Luisa
authors.initials: JL
authors.lastname: Muñoz
authors.affiliation: Departamento de Métodos Estadísticos, Universidad de Zaragoza, Zaragoza, Spain.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Sanz
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000175:diagnosis; D009367:Neoplasm Staging; D049451:Nomograms; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies
chemical_list: D000726:Androgen Antagonists; D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: Adjuvant therapy; Gleason score; Prostate-specific antigen; Radiation dose; Survival