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Table 3 Prognostic tools relating to external beam radiation therapy

From: An appraisal of analytical tools used in predicting clinical outcomes following radiation therapy treatment of men with prostate cancer: a systematic review

Author

Model type

Variables

Variable readily available?

Validation (I/E)

Accuracy

Metric

Sample size (events)

Outcome

Tx

Zaorsky [65]

Survival model

Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages.

Yes

External validation of AJCC version 6

0.54

c-index

2469 (NR)

OS

3D-CRT, IMRT

Zaorsky [65]

Survival model

Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages.

Yes

External validation of AJCC version 7

0.54

c-index

2469 (NR)

OS

3D-CRT, IMRT

Vainshtein [18]

Survival model (Cox)

CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer)

Yes

External validation of CAPRA

0.56

c-index

85 (NR)

PCSM

EBRT with long term Androgen deprivation

Zaorsky [65]

Survival model

Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages.

Yes

External validation of AJCC version 7

0.58

c-index

2469 (NR)

OS

3D-CRT, IMRT

Zaorsky [65]

Survival model

Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages.

Yes

External validation of AJCC version 6

0.52

c-index

2469 (NR)

BCF

3D-CRT, IMRT

Zaorsky [65]

Survival model

Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, tages.

Yes

External validation of AJCC version 7

0.6

c-index

2469 (NR)

BCF

3D-CRT, IMRT

Vance [60]

Survival model (Cox)

PSA, Gleason, clinical T stage, PCV, ADT use

Yes

Not stated

0.61 95% CI 0.53-0.68

c-index

599 (NR)

OS

EBRT

Buyyounouski [38]

Survival model

Interval to Biochemical failure (dicotomized at 18 months)

Yes

External validation of IBF

0.61; 95% CI 0.58-0.65; 48.4%; 86.1%

c-index; sensitivity; specificity.

1722 (290)

PCSM

EBRT

Westphalen [62]

Survival (Cox, Nomogram presented)

PSA level, clinical stage (from digital rectal examination findings), sum of Gleason grades, use of neoadjuvant ADT, and radiation dose

Yes

External validation of Kattan with additions

0.61; 95% CI 0.581-0.640

c-index

99 (30)

BCF

EBRT

Qian [52]

Survival model (Cox)

NCCN risk stratification tool plus percent positive cores

Yes

Not stated

0.63

c-index

652 (NR)

BFFF

3D-CRT, IMRT

Vance [60]

Survival model (Cox)

PSA, Gleason, clinical T stage, PCV, ADT use

No (prostate cancer volume)

Not stated

0.64; 95% CI 0.57-0.70

c-index

599 (NR)

BFFF

EBRT

Qian [52]

Survival model (Cox)

NCCN risk stratification tool plus percent positive cores

Yes

Not stated

0.64

c-index

652 (NR)

Metastases

3D-CRT, IMRT

Vainshtein [18]

Survival model (Cox)

CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer)

Yes

External validation of CAPRA

0.67

c-index

85 (NR)

BFFF

EBRT with long term Androgen deprivation

Zelefsky [66]

Survival (Cox, Nomogram presented)

ADT, T stage, Gleason, Pre PSA, RT dose.

Yes

Not stated

0.67

c-index

2551

BFFF

3D-CRT, IMRT

Vance [60]

Survival model (Cox)

PSA, Gleason, clinical T stage, PCV, ADT use

No (prostate cancer volume)

Not stated

0.67; 95% CI 0.60-0.74

c-index

599 (NR)

FFM

EBRT

Zaorsky [65]

Survival model

Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages.

Yes

External validation of AJCC version 6

0.68

c-index

2469 (NR)

PCSM

3D-CRT, IMRT

Halverson [46]

Survival model (Cox)

CAPRA: PSA, T stage, Gleason score, percent positive biopsy, and age

Yes

External validation of CAPRA

0.69

c-index

612 (NR)

BFFF

EBRT

Zaorsky [65]

Survival model

Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages.

Yes

External validation of AJCC version 6

0.70

c-index

2469 (NR)

DM

3D-CRT, IMRT

Qian [52]

Survival model (Cox)

NCCN risk stratification tool plus percent positive cores

Yes

Not stated

0.71

c-index

652 (NR)

PCSM

3D-CRT, IMRT

Zelefsky [68]

Survival (Cox, Nomogram presented)

T stage, Gleason Score, radiation dose, Neoadjuvant ADT, Pre-treatment PSA level,

Yes

Internal (bootstrapping)

0.72

c-index

2253 (578)

BCF

3D-CRT, IMRT

Williams [17]

Survival (Cox, Nomogram presented)

Age, prostate-specific antigen value, Gleason score, clinical stage, androgen deprivation duration, and radiotherapy dose

Yes

Not stated

0.72

c-index

3264 (1048)

BCF

EBRT

Vainshtein [18]

Survival model (Cox)

CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer)

Yes

External validation of CAPRA

0.73

c-index

153 (NR)

PCSM

EBRT with short term Androgen deprivation

Steigler [56]

Survival Model (Fine and Gray)

PSA doubling time (PSADT definition specified), time to biochemical failure, high risk category defined by PSADT <4 months or TTBF < 1 year and low risk category by PSADT >9 months or TTBF > 3 years.

Yes

Internal (bootstrapping)

0.73

c-index

485 (150)

PCSM

EBRT

Vance [60]

Survival model (Cox)

PSA, Gleason, clinical T stage, PCV, ADT use

No (prostate cancer volume)

Not stated

0.75; 95% CI 0.67-0.83

c-index

599 (NR)

PCSM

EBRT

Zaorsky [65]

Survival model

Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages.

Yes

External validation of AJCC version 7

0.75

c-index

2469 (NR)

DM

3D-CRT, IMRT

Sanpaolo [21]

Survival (Cox, Nomogram presented)

Age, Gleason score, tumor stage, initial PSA, androgen deprivation therapy, pelvic radiotherapy, administered doses, days of radiotherapy, and biologically effective dose

Yes

Internal (bootstrapping)

0.75

c-index

670 (70)

BCF

3D-CRT

Vainshtein [18]

Survival model (Cox)

CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer)

Yes

External validation of CAPRA

0.78

c-index

612 (51)

FFM

EBRT

Vainshtein [18]

Survival model (Cox)

CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer)

Yes

External validation of CAPRA

0.79

c-index

374 (NR)

FFM

EBRT (no ADT)

Vainshtein [18]

Survival model (Cox)

CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer)

Yes

External validation of CAPRA

0.80

c-index

612 (23)

PCSM

EBRT

Vainshtein [18]

Survival model (Cox)

CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer)

Yes

External validation of CAPRA

0.80

c-index

153 (NR)

FFM

EBRT with short term Androgen deprivation

Zaorsky [65]

Survival model

Score derived from: Age, PSA, Gleason Score, ADT, Radiation dose, Stages.

Yes

External validation of AJCC version 7

0.81

c-index

2469 (NR)

PCSM

3D-CRT, IMRT

Proust-Lima [51]

Joint Model (Latent Class)

Repeat PSA measures

No

External (two separate cohorts n =503 and 615)

0.82

Weighted average error of prediction (WAEP) at 1 year; after 3 years 0.0614, 0.0095.

1268 (190)

Clinical recurrence

EBRT

Vainshtein [18]

Risk stratification

CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer)

Yes

External validation of CAPRA

0.86

c-index

374 (NR)

PCSM

EBRT (no ADT)

Yu [63]

Joint modelling

T stage, ln(PSA), Gleason, Age, dose, duration of RT, PSA, slope, HT, Baseline hazards, measurementerrors and tuning parameters.

No, baseline hazards, measurement errors, tuning parameters included

External (prospective on 612 patients from the original cohort)

Not stated

NA

928 (24)

BCF

EBRT

Yu [64]

Survival model (Cox)

Peri-neurial invasion, clinical T stage, Gleason, pre-treatment PSA, radiation dose, ADT

Yes

Not stated

Not stated

NA

657 (145)

BCF

EBRT

Cooperberg [40]

Survival model (Weibull parametric)

CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer)

Yes

External

Not stated

NA

1143 (NR)

10 year PCSM

EBRT

Cooperberg [39]

Survival model (Cox)

CAPRA scores (based on PSA, Biopsy Gleason, Age at diagnosis, clinical tumour stage and % biopsy cores positive for cancer)

Yes

External

Not stated

NA

1262 (62)

PCSM

EBRT

Zumsteg [69]

Survival model (Cox)

Stratification for NCCN intermediate risk patients based on: Gleason, % Positive biospy cores and number of intermediate risk factors

Yes

Not stated

Not stated

NA

424 (NR)

BFFF

EBRT

Zumsteg [69]

Survival Model (Fine and Gray)

Stratification for NCCN intermediate risk patients based on: Gleason, % Positive biospy cores and number of intermediate risk factors

Yes

Not stated

Not stated

NA

424 (NR)

PCSM

EBRT

Zumsteg [69]

Survival model (Cox)

Stratification for NCCN intermediate risk patients based on: Gleason, % Positive biospy cores and number of intermediate risk factors

Yes

Not stated

Not stated

NA

424 (NR)

LF

EBRT

Zumsteg [69]

Survival model (Cox)

Stratification for NCCN intermediate risk patients based on: Gleason, % Positive biospy cores and number of intermediate risk factors

Yes

Not stated

Not stated

NA

424 (NR)

DM

EBRT

Zelefsky [67]

Survival Model (Fine and Gray)

T stage, Gleason, RT dose, pre-RT PSA, Nadir PSA

Yes

Not stated

Not stated

NA

812 (81)

DM

3D-CRT, IMRT

Zelefsky [67]

Survival Model (Fine and Gray)

T stage, Gleason, RT dose, pre-RT PSA, Nadir PSA

Yes

Not stated

Not stated

NA

843 (65)

PCSM

3D-CRT, IMRT

Zelefsky [67]

Survival model (Cox)

T stage, Gleason, RT dose, pre-RT PSA, Nadir PSA

Yes

Not stated

Not stated

NA

769 (246)

BFFF

3D-CRT, IMRT

Thames [59]

Survival model (Cox)

T stage, Gleason Score, ln(initial PSA), PSA indicator interval, non-treatment day ratio, dose, Overall treatment time

No, Institution adjustment and PSA interval are cohort specific

Not stated

Not stated

NA

3426 (1445)

BCF

2D or 3D-CRT

Taylor [58]

Joint model (longitudinal and survival)

Gleason score, T stage, PSA before treatment, Dose and date of radiation, Serial PSA values after treatment

Yes

External (separate cohort not stated)

Not stated

NA

3232 (458)

Clinical recurrence (local, regional or distant)

EBRT

Murgic [50]

Survival model (Cox)

Age, PSA, T-stage, Gleason, ADT use, Pelvic RT, RT dose, Maximum biopsy core, percent positive cores

No, pelvic RT included

Not stated

Not stated

NA

590 (NR)

BFFF

EBRT

Murgic [50]

Survival model (Cox)

Age, PSA, T-stage, Gleason, ADT use, Pelvic RT, RT dose, Maximum biopsy core, percent positive cores

No, pelvic RT included

Not stated

Not stated

NA

590 (NR)

FFM

EBRT

Murgic [50]

Survival model (Cox)

Age, PSA, T-stage, Gleason, ADT use, Pelvic RT, RT dose, Maximum biopsy core, percent positive cores

Yes, pelvic RT included

Not stated

Not stated

NA

590 (NR)

PCSM

EBRT

Murgic [50]

Survival model (Cox)

Age, PSA, T-stage, Gleason, ADT use, Pelvic RT, RT dose, Maximum biopsy core, percent positive cores

Yes, pelvic RT included

Not stated

Not stated

NA

590 (NR)

OS

EBRT

Spratt [55]

Survival model (Cox)

Age, T-stage, Gleason score, pre-treatment PSA, >50% core involvement, use of ADT, and PSA density

Yes, PSA density can be calculated

Not stated

Not stated

NA

1002 (NR)

BCF

IMRT

Spratt [55]

Survival model (Cox)

Age, T-stage, Gleason score, pre-treatment PSA, >50% core involvement, use of ADT, and PSA density

Yes, PSA density can be calculated

Not stated

Not stated

NA

1002 (NR)

DMFS

IMRT

Spratt [55]

Survival Model (Fine and Gray)

Age, T-stage, Gleason score, pre-treatment PSA, >50% core involvement, use of ADT, and PSA density

Yes, PSA density can be calculated

Not stated

Not stated

NA

1002 (NR)

PCSM

IMRT

Sabolch [53]

Survival model (Cox)

Pre-treatment PSA, T-stage, Gleason score, GP5, ADT, and Charlson comorbidity index.

No, includes Charlson comorbidity index

Not stated

Not stated

NA

718 (NR)

BFFF

3D CT or IMRT

Sabolch [53]

Survival model (Cox)

Pre-treatment PSA, T-stage, Gleason score, GP5, ADT, and Charlson comorbidity index.

No, includes Charlson comorbidity index

Not stated

Not stated

NA

718 (NR)

Freedom from Metastases

3D CT or IMRT

Sabolch [53]

Survival model (Cox)

Pre-treatment PSA, T-stage, Gleason score, GP5, ADT, and Charlson comorbidity index.

No, includes Charlson comorbidity index

Not stated

Not stated

NA

718 (NR)

PCSM

3D CT or IMRT

Sabolch [53]

Survival model (Cox)

Pre-treatment PSA, T-stage, Gleason score, GP5, ADT, and Charlson comorbidity index.

No, includes Charlson comorbidity index

Not stated

Not stated

NA

718 (NR)

OS

3D CT or IMRT

Huang [47]

Survival model (Cox)

Gleason score, iPSA, and % positive cores

Yes

Not stated

Not stated

NA

1056 (176)

BCF

EBRT

Huang [47]

Survival Model (Fine and Gray)

Gleason score, iPSA, and % positive cores

Yes

Not stated

Not stated

NA

1056 (30)

PCSM

EBRT

Huang [47]

Survival model (Cox)

Gleason score, iPSA, and % positive cores

Yes

Not stated

Not stated

NA

1056 (634)

OS

EBRT

Feng [28]

Survival model (Cox); also recursive partitioning

age, race, T stage, PSA, No of biopsy cores taken, percent positive cores, Gleason Score, NCCN risk group, RT dose, Pelvic RT, ADT

No, includes pelvic RT

Not stated

Not stated

NA

651 (NR)

FFM

EBRT

Feng [28]

Survival model (Cox); also recursive partitioning

age, race, T stage, PSA, No of biopsy cores taken, percent positive cores, Gleason Score, NCCN risk group, RT dose, Pelvic RT, ADT

No, includes pelvic RT

Not stated

Not stated

NA

651 (NR)

PCSM

EBRT

Feng [28]

Survival model (Cox); also recursive partitioning

age, race, T stage, PSA, No of biopsy cores taken, percent positive cores, Gleason Score, NCCN risk group, RT dose, Pelvic RT, ADT

No, Includes pelvic RT

Not stated

Not stated

NA

651 (NR)

BFFF

EBRT

Feng [28]

Survival model (Cox); also recursive partitioning

age, race, T stage, PSA, No of biopsy cores taken, percent positive cores, Gleason Score, NCCN risk group, RT dose, Pelvic RT, ADT

No, includes Pelvic RT

Not stated

Not stated

NA

651 (NR)

OS

EBRT

Engineer [9]

Survival model (Cox)

Age, Tumour stage, Gleason score, PSA, ADT, radiation dose, period of treatment

No, includes period of treatment

Not stated

Not stated

NA

174 (21)

BFFF

2D or 3D-CRT

Engineer [9]

Survival model (Cox)

Age, Tumour stage, Gleason score, PSA, ADT, radiation dose, period of treatment

No, includes period of treatment

Not stated

Not stated

NA

174 (98)

Disease free survival

2D or 3D-CRT

Engineer [9]

Survival model (Cox)

Age, Tumour stage, Gleason score, PSA, ADT, radiation dose, period of treatment

No, includes period of treatment

Not stated

Not stated

NA

174 (124)

OS

2D or 3D-CRT

Denham [44]

Survival model (Cox)

Time to biochemical failure

Yes

Not stated

Not stated

NA

802 (125)

PCSM

EBRT

Denham [44]

Survival model (Cox)

PSA doubling time

No, multiple PSA measures required

Not stated

Not stated

NA

802 (125)

PCSM

EBRT

D’Amico [43]

Survival Model (Fine and Gray)

PSA velocity, biopsy Gleason score, PSA, and clinical stage

No, PSA velocity

Not stated

Not stated

NA

288 (32)

PCSM

3D-CRT

Slater [54]

Survival model (Cox)

NCCN grouping, percent positive biopsy cores (PPBC), percentage of cancer volume (PCV), maximum involvement of biopsy scores (MIBC)

No, percentage cancer volume

Not stated

Not stated

NA

398 (NR)

bNED

Proton and photonbeam therapy

D’Ambrosio [41]

Survival model (Cox)

Non-treatment day ratio, absolute number of non-treatment days, Gleason, pre-treatment PSA, T stage, radiation dose

No, includes treatment days

Not stated

Not stated

NA

1796 (NR)

BCF

3D-CRT, IMRT

  1. Abbreviations: OS overall survival, RT radiotherapy, BCF bio chemical failure, BFFF bio chemical freedom from failure, PCSM prostate cancer specific mortality, LF local failure, DM distant metastases, DMFS distant metastases-free survival, FFM freedom from metastases, TTBF time to bio chemical failure, STI secondary therapeutic intervention, bNED bio chemical no evidence of disease, 2D-CRT 2D - Conformal radiotherapy; 3D-CRT 3D -Conformal radiotherapy, EBRT external beam radiotherapy, NA not applicable, NR not reported