Development and validation of a novel clinical-radiological-pathological scoring system for preoperative prediction of extraprostatic extension in prostate cancer: a multicenter retrospective study
Abstract Objective To develop and validate a multimodal scoring system integrating clinical, radiological, and pathological variables to preoperatively predict extraprostatic extension (EPE) in prostate cancer (PCa). Methods This retrospective study included 667 PCa patients divided into a derivatio...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-07-01
|
| Series: | Cancer Imaging |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40644-025-00905-w |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849767313461477376 |
|---|---|
| author | Liqin Yang Pengfei Jin Ximing Wang Zhiping Li Huijing Xu Yongsheng Zhang Feng Cui |
| author_facet | Liqin Yang Pengfei Jin Ximing Wang Zhiping Li Huijing Xu Yongsheng Zhang Feng Cui |
| author_sort | Liqin Yang |
| collection | DOAJ |
| description | Abstract Objective To develop and validate a multimodal scoring system integrating clinical, radiological, and pathological variables to preoperatively predict extraprostatic extension (EPE) in prostate cancer (PCa). Methods This retrospective study included 667 PCa patients divided into a derivation cohort and two validation cohorts. Evaluated parameters comprised prostate-specific antigen density (PSAD), curvilinear contact length (CCL), lesion longest diameter (LD), National Cancer Institute EPE grade (NCI_EPE), International Society of Urological Pathology grade (ISUP), and other relevant variables. Independent predictors were identified through univariate and multivariate regression analysis to construct a logistic model. Coefficients from this model were then weighted to establish a scoring system. The predictive performance of the NCI_EPE, logistic model, and scoring system was systematically evaluated and compared. Finally, the scoring system was stratified into four distinct risk categories. Results Multivariate analysis identified NCI_EPE, PSAD, CCL/LD, and ISUP as independent predictors of EPE. In the derivation and validation cohorts, the scoring system demonstrated robust predictive accuracy for EPE, with AUCs of 0.849, 0.830, and 0.847, respectively. These values outperformed the NCI_EPE (Derivation cohort: 0.849 vs. 0.750, P < 0.003, Validation cohort 1: 0.830 vs. 0.736, P = 0.138, Validation cohort 2: 0.837 vs. 0.715, P = 0.003) and were comparable to the logistic model (Derivation cohort: 0.849 vs. 0.860, P = 0.228, Validation cohort 1: 0.830 vs. 0.849, P = 0.711, Validation cohort 2: 0.837 vs. 0.843, P = 0.738). Decision curve analysis revealed higher net clinical benefit for both the scoring system and logistic model compared to the NCI_EPE. Risk stratification using the scoring system categorized patients into four tiers: low (0–3), intermediate-low (4–6), intermediate-high (7–9), and high risk (10–12) with corresponding mean EPE probabilities of 9.9%, 26.0%, 52.0%, and 85.0%. These probabilities closely aligned with observed pT3 incidences in the derivation and validation cohorts. Conclusions The scoring system provides enhanced predictive accuracy for EPE, preoperatively stratifying patients into distinct risk categories to facilitate personalized therapeutic strategies. |
| format | Article |
| id | doaj-art-c19b1392dfc04b3aae3e6c519ba8ef70 |
| institution | DOAJ |
| issn | 1470-7330 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Cancer Imaging |
| spelling | doaj-art-c19b1392dfc04b3aae3e6c519ba8ef702025-08-20T03:04:15ZengBMCCancer Imaging1470-73302025-07-0125111410.1186/s40644-025-00905-wDevelopment and validation of a novel clinical-radiological-pathological scoring system for preoperative prediction of extraprostatic extension in prostate cancer: a multicenter retrospective studyLiqin Yang0Pengfei Jin1Ximing Wang2Zhiping Li3Huijing Xu4Yongsheng Zhang5Feng Cui6Department of Radiology, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical UniversityDepartment of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesDepartment of Radiology, The First Affiliated Hospital of Soochow UniversityDepartment of Radiology, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical UniversityDepartment of Radiology, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical UniversityDepartment of Radiology, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical UniversityDepartment of Radiology, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical UniversityAbstract Objective To develop and validate a multimodal scoring system integrating clinical, radiological, and pathological variables to preoperatively predict extraprostatic extension (EPE) in prostate cancer (PCa). Methods This retrospective study included 667 PCa patients divided into a derivation cohort and two validation cohorts. Evaluated parameters comprised prostate-specific antigen density (PSAD), curvilinear contact length (CCL), lesion longest diameter (LD), National Cancer Institute EPE grade (NCI_EPE), International Society of Urological Pathology grade (ISUP), and other relevant variables. Independent predictors were identified through univariate and multivariate regression analysis to construct a logistic model. Coefficients from this model were then weighted to establish a scoring system. The predictive performance of the NCI_EPE, logistic model, and scoring system was systematically evaluated and compared. Finally, the scoring system was stratified into four distinct risk categories. Results Multivariate analysis identified NCI_EPE, PSAD, CCL/LD, and ISUP as independent predictors of EPE. In the derivation and validation cohorts, the scoring system demonstrated robust predictive accuracy for EPE, with AUCs of 0.849, 0.830, and 0.847, respectively. These values outperformed the NCI_EPE (Derivation cohort: 0.849 vs. 0.750, P < 0.003, Validation cohort 1: 0.830 vs. 0.736, P = 0.138, Validation cohort 2: 0.837 vs. 0.715, P = 0.003) and were comparable to the logistic model (Derivation cohort: 0.849 vs. 0.860, P = 0.228, Validation cohort 1: 0.830 vs. 0.849, P = 0.711, Validation cohort 2: 0.837 vs. 0.843, P = 0.738). Decision curve analysis revealed higher net clinical benefit for both the scoring system and logistic model compared to the NCI_EPE. Risk stratification using the scoring system categorized patients into four tiers: low (0–3), intermediate-low (4–6), intermediate-high (7–9), and high risk (10–12) with corresponding mean EPE probabilities of 9.9%, 26.0%, 52.0%, and 85.0%. These probabilities closely aligned with observed pT3 incidences in the derivation and validation cohorts. Conclusions The scoring system provides enhanced predictive accuracy for EPE, preoperatively stratifying patients into distinct risk categories to facilitate personalized therapeutic strategies.https://doi.org/10.1186/s40644-025-00905-wProstate CancerExtraprostatic ExtensionScoring SystemRisk Stratification |
| spellingShingle | Liqin Yang Pengfei Jin Ximing Wang Zhiping Li Huijing Xu Yongsheng Zhang Feng Cui Development and validation of a novel clinical-radiological-pathological scoring system for preoperative prediction of extraprostatic extension in prostate cancer: a multicenter retrospective study Cancer Imaging Prostate Cancer Extraprostatic Extension Scoring System Risk Stratification |
| title | Development and validation of a novel clinical-radiological-pathological scoring system for preoperative prediction of extraprostatic extension in prostate cancer: a multicenter retrospective study |
| title_full | Development and validation of a novel clinical-radiological-pathological scoring system for preoperative prediction of extraprostatic extension in prostate cancer: a multicenter retrospective study |
| title_fullStr | Development and validation of a novel clinical-radiological-pathological scoring system for preoperative prediction of extraprostatic extension in prostate cancer: a multicenter retrospective study |
| title_full_unstemmed | Development and validation of a novel clinical-radiological-pathological scoring system for preoperative prediction of extraprostatic extension in prostate cancer: a multicenter retrospective study |
| title_short | Development and validation of a novel clinical-radiological-pathological scoring system for preoperative prediction of extraprostatic extension in prostate cancer: a multicenter retrospective study |
| title_sort | development and validation of a novel clinical radiological pathological scoring system for preoperative prediction of extraprostatic extension in prostate cancer a multicenter retrospective study |
| topic | Prostate Cancer Extraprostatic Extension Scoring System Risk Stratification |
| url | https://doi.org/10.1186/s40644-025-00905-w |
| work_keys_str_mv | AT liqinyang developmentandvalidationofanovelclinicalradiologicalpathologicalscoringsystemforpreoperativepredictionofextraprostaticextensioninprostatecanceramulticenterretrospectivestudy AT pengfeijin developmentandvalidationofanovelclinicalradiologicalpathologicalscoringsystemforpreoperativepredictionofextraprostaticextensioninprostatecanceramulticenterretrospectivestudy AT ximingwang developmentandvalidationofanovelclinicalradiologicalpathologicalscoringsystemforpreoperativepredictionofextraprostaticextensioninprostatecanceramulticenterretrospectivestudy AT zhipingli developmentandvalidationofanovelclinicalradiologicalpathologicalscoringsystemforpreoperativepredictionofextraprostaticextensioninprostatecanceramulticenterretrospectivestudy AT huijingxu developmentandvalidationofanovelclinicalradiologicalpathologicalscoringsystemforpreoperativepredictionofextraprostaticextensioninprostatecanceramulticenterretrospectivestudy AT yongshengzhang developmentandvalidationofanovelclinicalradiologicalpathologicalscoringsystemforpreoperativepredictionofextraprostaticextensioninprostatecanceramulticenterretrospectivestudy AT fengcui developmentandvalidationofanovelclinicalradiologicalpathologicalscoringsystemforpreoperativepredictionofextraprostaticextensioninprostatecanceramulticenterretrospectivestudy |