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首页> 外文期刊>BMC Medical Informatics and Decision Making >A risk calculator to inform the need for a prostate biopsy: a rapid access clinic cohort
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A risk calculator to inform the need for a prostate biopsy: a rapid access clinic cohort

机译：风险计算器，以告知需要前列腺活检：快速访问诊所队列

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Prostate cancer (PCa) represents a significant healthcare problem. The critical clinical question is the need for a biopsy. Accurate risk stratification of patients before a biopsy can allow for individualised risk stratification thus improving clinical decision making. This study aims to build a risk calculator to inform the need for a prostate biopsy. Using the clinical information of 4801 patients an Irish Prostate Cancer Risk Calculator (IPRC) for diagnosis of PCa and high grade (Gleason ≥7) was created using a binary regression model including age, digital rectal examination, family history of PCa, negative prior biopsy and Prostate-specific antigen (PSA) level as risk factors. The discrimination ability of the risk calculator is internally validated using cross validation to reduce overfitting, and its performance compared with PSA and the American risk calculator (PCPT), Prostate Biopsy Collaborative Group (PBCG) and European risk calculator (ERSPC) using various performance outcome summaries. In a subgroup of 2970 patients, prostate volume was included. Separate risk calculators including the prostate volume (IPRCv) for the diagnosis of PCa (and high-grade PCa) was created. IPRC area under the curve (AUC) for the prediction of PCa and high-grade PCa was 0.6741 (95% CI, 0.6591 to 0.6890) and 0.7214 (95% CI, 0.7018 to 0.7409) respectively. This significantly outperforms the predictive ability of cancer detection for PSA (0.5948), PCPT (0.6304), PBCG (0.6528) and ERSPC (0.6502) risk calculators; and also, for detecting high-grade cancer for PSA (0.6623) and PCPT (0.6804) but there was no significant improvement for PBCG (0.7185) and ERSPC (0.7140). The inclusion of prostate volume into the risk calculator significantly improved the AUC for cancer detection (AUC?=?0.7298; 95% CI, 0.7119 to 0.7478), but not for high-grade cancer (AUC?=?0.7256; 95% CI, 0.7017 to 0.7495). The risk calculator also demonstrated an increased net benefit on decision curve analysis. The risk calculator developed has advantages over prior risk stratification of prostate cancer patients before the biopsy. It will reduce the number of men requiring a biopsy and their exposure to its side effects. The interactive tools developed are beneficial to translate the risk calculator into practice and allows for clarity in the clinical recommendations.
机译：前列腺癌（PCA）代表了一个重要的医疗保健问题。关键的临床问题是需要活组织检查。精确风险分层患者在活组织检查之前可以允许个性化风险分层，从而改善临床决策。本研究旨在建立一个风险计算器，以告知需要前列腺活检。使用4801名患者的临床信息，使用包括年龄，数字直肠检查，PCA家族历史的二进制回归模型来创建用于诊断PCA和高品位（GLEASON≥7）的IRISH前列腺癌风险计算器（IPRC）。和前列腺特异性抗原（PSA）水平作为风险因素。风险计算器的歧视能力是使用交叉验证的内部验证，以减少过度装备，与PSA和美国风险计算器（PCPT），前列腺活组织检查协作组（PBCG）和欧洲风险计算器（ERSPC）相比，其性能与各种性能结果相比摘要。在2970名患者的亚组中，包括前列腺体积。包括用于诊断PCA（和高档PCA）的前列腺体积（IPRCV）的单独风险计算器。用于预测PCA和高级PCA的曲线（AUC）下的IPRC区域为0.6741（95％CI，0.6591至0.6890）和0.7214（95％CI，0.7018至0.7409）。这显着优异地优于PSA（0.5948），PCPT（0.6304），PBCG（0.6528）和ERSPC（0.6502）风险计算器的预测能力;并且还用于检测PSA（0.6623）和PCPT（0.6804）的高级癌症，但PBCG（0.7185）和ERSPC（0.7140）没有显着改善。将前列腺体积包含到风险计算器中显着改善了癌症检测的AUC（AUC？= 0.7298; 95％CI，0.7119至0.7478），但不是高级癌症（AUC？= 0.7256; 95％CI， 0.7017至0.7495）。风险计算器还展示了关于决策曲线分析的净利润增加。风险计算器开发的优势在活组织检查前前列腺癌患者的前列风险分层具有优势。它将减少需要活组织检查的人数及其暴露于其副作用。开发的互动工具有利于将风险计算器转化为实践，并在临床推荐中允许清楚起见。

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