Successful external validation of a model to predict other cause mortality in localized prostate cancer

• Type of Material: Article
• Authors: Matthew Kent, Memorial Sloan-Kettering Cancer Center; David F. Penson, Vanderbilt University; Peter C. Albertsen, University of Connecticut Health Center; Michael Goodman, Emory University; Ann S. Hamilton, University of Southern California; Janet L. Stanford, Fred Hutchinson Cancer Research Center; Antoinette M. Stroup, New Jersey State Cancer Registry; Behfar Ehdaie, Memorial Sloan-Kettering Cancer Center; Peter T. Scardino, Memorial Sloan-Kettering Cancer Center; Andrew J. Vickers, Memorial Sloan-Kettering Cancer Center
• Language: English
• Date: 2016-02-09
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2016 Kent et al. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12916-016-0572-z
• Title of Journal or Parent Work: BMC Medicine
• ISSN: 1741-7015
• Volume: 14
• Issue: 1
• Start Page: 25
• End Page: 25
• Grant/Funding Information: Supported in part by funds from David H. Koch provided through the Prostate Cancer Foundation, the Sidney Kimmel Center for Prostate and Urologic Cancers, P50-CA92629 SPORE grant from the National Cancer Institute (NCI) to Dr. H Scher, and the P30-CA008748 National Institutes of Health (NIH)/NCI Cancer Center Support Grant to MSKCC, the NCI, National Institutes of Health (grant R01-CA114524), and the following contracts from the each of the participating institutions: N01-PC-67007; N01-PC-67009; N01-PC-67010; N01-PC-67006; N01-PC-67005; and N01-PC-67000.
• Keywords: Science & Technology; Life expectancy; ANTIGEN; OUTCOMES; Medicine, General & Internal; RISK; MEN; Prediction; Clinical decision support; Life Sciences & Biomedicine; General & Internal Medicine; DEATH; Radical prostatectomy; METASTASIS
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Biology, Biostatistics

Abstract

Background: Although life expectancy estimation is vital to decision making for localized prostate cancer, there are few, if any, valid and usable tools. Our goal was to create and validate a prediction model for other cause mortality in localized prostate cancer patients that could aid clinician's initial treatment decisions at the point of care. Methods: We combined an adjusted Social Security Administration table with a subset of comorbidities from a UK actuarial life expectancy model. Life tables were adjusted on the basis of survival data from a cohort of almost 10,000 radical prostatectomy patients treated at four major US academic institutions. Comorbidity-specific odds ratios were calculated and incorporated with baseline risk of mortality. We externally validated the model on 2898 patients from the Prostate Cancer Outcomes Study, which included men diagnosed with prostate cancer in six SEER cancer registries. These men had sufficient follow-up for our endpoints of 10- and 15-year mortality and also had self-reported comorbidity data. Results: Life expectancy for prostate cancer patients were close to that of a typical US man who was 3 years younger. On external validation, 10- and 15-year concordance indexes were 0.724 and 0.726, respectively. Our model exhibited excellent calibration. Taking into account differences between how comorbidities are used in the model versus how they were recorded in the validation cohort, calibration would improve for most patients, but there would be overestimation of the risk of death in the oldest and sickest patients. Conclusions: We successfully created and externally validated a new life expectancy prediction model that, while imperfect, has clear advantages to any alternative. We urge consideration of its use in counseling patients with localized prostate cancer.