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

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=101) 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 241) 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.

journal_name

Br J Cancer

authors

Vergouwe Y,Steyerberg EW,de Wit R,Roberts JT,Keizer HJ,Collette L,Stenning SP,Habbema JD

doi

10.1038/sj.bjc.6600759

subject

Has Abstract

pub_date

2003-03-24 00:00:00

pages

843-7

issue

6

eissn

0007-0920

issn

1532-1827

pii

6600759

journal_volume

88

pub_type

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