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External validity of a prediction rule for residual mass histology in testicular cancer: an evaluation for good prognosis patients

Lookup NU author(s): Dr James Roberts

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Abstract

We assessed the external validity of a prediction rule for nonseminomatous testicular cancer patients. The rule was developed to predict the probability of retroperitoneal metastases being benign (only necrosis/fibrosis) after chemotherapy treatment. Patients with a high probability of benign residual masses might be offered surveillance as opposed to patients with a low probability, who should undergo retroperitoneal lymph node dissection (RPLND). We compared the observed histology with the predicted probability in 105 patients with good prognosis germ cell cancer who underwent RPLND between 1995 and 1998. We found that predicted probabilities higher than 5% were in good agreement with the observed frequencies of benign masses. The area under the receiver operating characteristic curve was 0.76, suggesting that the rule could reasonably discriminate between benign masses and tumour. However, nearly all predicted probabilities (n = 10 1) were lower than 70%, which might be considered as the lowest value at which surveillance offers a reasonable alternative to RPLND. Further, 35% of patients currently under surveillance (84 out of 24 1) had predicted probabilities lower than 70%. In conclusion, the clinical relevance of the prediction rule was limited for the patients who underwent RPLND; use of the rule would change the policy from RPLND to surveillance in only a few. On the other hand, the rule might support selection of patients for RPLND, who currently are under surveillance. (C) 2003 Cancer Research UK.


Publication metadata

Author(s): Vergouwe Y, Steyerberg EW, de Wit R, Roberts JT, Keizer HJ, Collette L, Stenning SP, Habbema JDF

Publication type: Article

Publication status: Published

Journal: British Journal of Cancer

Year: 2003

Volume: 88

Issue: 6

Pages: 843-847

ISSN (print): 0007-0920

ISSN (electronic): 1532-1827

Publisher: Nature Publishing Group

URL: http://dx.doi.org/10.1038/sj.bjc.6600759

DOI: 10.1038/sj.bjc.6600759


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