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Meta-Analysis
. 2019 Jan 7;19(1):2.
doi: 10.1186/s12911-018-0727-2.

Meta-analysis of predictive models to assess the clinical validity and utility for patient-centered medical decision making: application to the CAncer of the Prostate Risk Assessment (CAPRA)

Marine Lorent  1 , Haïfa Maalmi  2 , Philippe Tessier  1 , Stéphane Supiot  3   4 , Etienne Dantan  1 , Yohann Foucher  5   6   7
Affiliations
Meta-Analysis

Meta-analysis of predictive models to assess the clinical validity and utility for patient-centered medical decision making: application to the CAncer of the Prostate Risk Assessment (CAPRA)

Marine Lorent et al. BMC Med Inform Decis Mak. .

Abstract

Background: The Cancer of the Prostate Risk Assessment (CAPRA) score was designed and validated several times to predict the biochemical recurrence-free survival after a radical prostatectomy. Our objectives were, first, to study the clinical validity of the CAPRA score, and, second, to assess its clinical utility for stratified medicine from an original patient-centered approach.

Methods: We proposed a meta-analysis based on a literature search using MEDLINE. Observed and predicted biochemical-recurrence-free survivals were compared to assess the calibration of the CAPRA score. Discriminative capacities were evaluated by estimating the summary time-dependent ROC curve. The clinical utility of the CAPRA score was evaluated according to the following stratified decisions: active monitoring for low-risk patients, prostatectomy for intermediate-risk patients, or radio-hormonal therapy for high risk patients. For this purpose, we assessed CAPRA's clinical utility in terms of its ability to maximize time-dependent utility functions (i.e. Quality-Adjusted Life-Years - QALYs).

Results: We identified 683 manuscripts and finally retained 9 studies. We reported good discriminative capacities with an area under the SROCt curve at 0.73 [95%CI from 0.67 to 0.79], while graphical calibration seemed acceptable. Nevertheless, we also described that the CAPRA score was unable to discriminate between the three medical alternatives, i.e. it did not allow an increase in the number of life years in perfect health (QALYs) of patients with prostate cancer.

Conclusions: We confirmed the prognostic capacities of the CAPRA score. In contrast, we were not able to demonstrate its clinical usefulness for stratified medicine from a patient-centered perspective. Our results also highlighted the confusion between clinical validity and utility. This distinction should be better considered in order to develop predictive tools useful in practice.

Keywords: Meta-analysis; Patient-centered outcomes; Prostate cancer; Stratified medicine.

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
The flowchart describing the 9 selected articles of the meta-analysis
Fig. 2
Fig. 2
The forest plots for pooled hazard ratios. a) High-risk group (CAPRA ≥6) versus the low-risk group (CAPRA ≤2). b) Intermediate-risk group (2 < CAPRA < 6) versus the low-risk group (CAPRA ≤2)
Fig. 3
Fig. 3
Calibration plots. a The pooled survival curves according to CAPRA-based strata compared to the survival curves from the original study. b Pooled survival versus observed survival in the original study
See this image and copyright information in PMC

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