Gregory T Chesnut1,2, Amy L Tin3, Katherine A Fleshner4, Nicole E Benfante5, Andrew J Vickers3, James A Eastham5, Daniel D Sjoberg3, Sigrid V Carlsson6,7,8. 1. Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. 2. Walter Reed National Military Medical Center, Bethesda, MD, USA. 3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 4. University of Calgary, Calgary, AB, Canada. 5. Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA. 6. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. carlssos@mskcc.org. 7. Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA. carlssos@mskcc.org. 8. Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. carlssos@mskcc.org.
Abstract
BACKGROUND: We assessed the concordance among urologists' judgment of health quartiles for patients with localized prostate cancer, and compared the life expectancy (LE) and ensuing treatment recommendations when following National Comprehensive Cancer Network (NCCN) guidelines based on actuarial life tables versus the Kent model, a validated LE prediction model. METHODS: NCCN suggests using actuarial life tables and relying on surgeon assessment of patient health to increase (for the best quartile) or decrease (for the worst quartile) LE by 50%. Eleven urologic surgeons allocated quartile of health and recommended treatments for ten patient vignettes. The 10-year survival probability was calculated using the Kent model and compared to the life-table estimate based on health quartile by surgeon consensus. RESULTS: Surgeon assessment agreed with the presumed true quartile of health based on a validated model in 41% of cases. For no case did three-quarters of surgeons assign health quartile correctly; in half of cases, <50% of surgeons assigned the correct quartile. The NCCN comorbidity-adjusted LE estimates underestimated risk of death in the best health quartile and overestimated risk of death in the worst health quartile, compared to the Kent model. Patients with LE > 10 years on NCCN estimation were recommended more frequently for surgery (81%) and those with ≤10 years estimated LE were more commonly recommended for radiation (57%) or observation (29%). CONCLUSIONS: A method based on physician-assessed health quartiles for LE estimation, as suggested by the NCCN guidelines, appears too crude to be used in the treatment counseling of men with localized prostate cancer, as compared to a validated prediction model, such as the Kent model.
BACKGROUND: We assessed the concordance among urologists' judgment of health quartiles for patients with localized prostate cancer, and compared the life expectancy (LE) and ensuing treatment recommendations when following National Comprehensive Cancer Network (NCCN) guidelines based on actuarial life tables versus the Kent model, a validated LE prediction model. METHODS: NCCN suggests using actuarial life tables and relying on surgeon assessment of patient health to increase (for the best quartile) or decrease (for the worst quartile) LE by 50%. Eleven urologic surgeons allocated quartile of health and recommended treatments for ten patient vignettes. The 10-year survival probability was calculated using the Kent model and compared to the life-table estimate based on health quartile by surgeon consensus. RESULTS: Surgeon assessment agreed with the presumed true quartile of health based on a validated model in 41% of cases. For no case did three-quarters of surgeons assign health quartile correctly; in half of cases, <50% of surgeons assigned the correct quartile. The NCCN comorbidity-adjusted LE estimates underestimated risk of death in the best health quartile and overestimated risk of death in the worst health quartile, compared to the Kent model. Patients with LE > 10 years on NCCN estimation were recommended more frequently for surgery (81%) and those with ≤10 years estimated LE were more commonly recommended for radiation (57%) or observation (29%). CONCLUSIONS: A method based on physician-assessed health quartiles for LE estimation, as suggested by the NCCN guidelines, appears too crude to be used in the treatment counseling of men with localized prostate cancer, as compared to a validated prediction model, such as the Kent model.
Authors: Patrick Kierkegaard; Mira D Vale; Spencer Garrison; Brent K Hollenbeck; John M Hollingsworth; Jason Owen-Smith Journal: J Surg Oncol Date: 2019-12-23 Impact factor: 3.454
Authors: Timothy J Daskivich; I-Chun Thomas; Michael Luu; Jeremy B Shelton; Danil V Makarov; Ted A Skolarus; John T Leppert Journal: J Urol Date: 2019-08-08 Impact factor: 7.450
Authors: Matthew Kent; David F Penson; Peter C Albertsen; Michael Goodman; Ann S Hamilton; Janet L Stanford; Antoinette M Stroup; Behfar Ehdaie; Peter T Scardino; Andrew J Vickers Journal: BMC Med Date: 2016-02-09 Impact factor: 8.775
Authors: Armin Shahrokni; Amy Tin; Koshy Alexander; Saman Sarraf; Anoushka Afonso; Olga Filippova; Jennifer Harris; Robert J Downey; Andrew J Vickers; Beatriz Korc-Grodzicki Journal: JAMA Netw Open Date: 2019-05-03