Construction of a nomogram for predicting upgraded Gleason scores after radical prostatectomy
Objective To construct and validate a nomogram to predict the risk of Gleason score upgrading(GSU)after radical prostatectomy(RP).Methods The clinical data of 179 patients who un-derwent RP at Wuhan Central Hospital from January 2018 to December 2022 were analyzed retrospectively.The data was randomly split into a training set and a validation set at a 6∶4 ratio using stratified random sampling method.Student's t-test was employed for normal distribution parametric data,Mann-Whitney U test for non-normal data,and Chi-square test for count data between groups,with P＜0.05 considered sta-tistically significant.Using LASSO-Logistic regression,key GSU predictors were identified for nomogram development.The model's efficacy was assessed via receiver operating characteristic curve,Hosmer-Leme-show(H-L)test,and decision curve analysis(DCA).Results The independent predictive factors for GSU included total prostate-specific antigen[odds ratio(OR):4.56,95％confidence interval(CI):1.79-11.64,P＜0.01],prostate imaging reporting and data system(PI-RADS)score(OR:3.47,95％CI:1.63-7.39,P＜0.01),percent free prostate-specific antigen density(OR:4.83,95％CI:1.07-21.74,P＜0.05),biopsy approach(OR:4.60,95％CI:1.61-13.15,P＜0.05),and biopsy Gleason score(OR:4.38,95％CI:1.29-14.90,P＜0.05).The area under the curve for the training and valida-tion sets wase 0.827(95％CI:0.750-0.905)and 0.799(95％CI:0.688-0.910),respectively.The H-L test indicated good calibration for the nomogram(training set:x2=5.501,P＞0.05;validation set:x2=11.986,P＞0.05)and DCA showed its usefulness.Conclusion This study built a nomogram for GSU risk prediction,demonstrating strong performance in internal tests.
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