Evidence map›Paper›PMID 32460859›Full record

ArticleBMC medicine2020

Risk stratification for prostate cancer management: value of the Cambridge Prognostic Group classification for assessing treatment allocation.

M G Parry, T E Cowling, A Sujenthiran, J Nossiter, B Berry, P Cathcart, A Aggarwal, H Payne, J van der Meulen, N W Clarke and 1 more

Abstract read
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In one paragraph

Article in BMC medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
34citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

34 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

M G ParryDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. mparry@rcseng.ac.uk.
T E CowlingDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
A SujenthiranClinical Effectiveness Unit, The Royal College of Surgeons of England, London, England.
J NossiterClinical Effectiveness Unit, The Royal College of Surgeons of England, London, England.
B BerryDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
P CathcartDepartment of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
A AggarwalDepartment of Cancer Epidemiology, Population, and Global Health, King's College London, London, UK.
H PayneDepartment of Oncology, University College London Hospitals, London, UK.
J van der MeulenDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
N W ClarkeDepartment of Urology, The Christie NHS Foundation Trust, Manchester, UK.
V J GnanapragasamAcademic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK.

Funding

Department of Health DRF-2018-11-ST2-036Medical Research Council MR/S020470/1Medical Research Council (GB) MR/S020470/1Research Trainees Coordinating Centre DRF-2018-11-ST2-036
6 · The paper itself

Abstract

backgroundThe five-tiered Cambridge Prognostic Group (CPG) classification is a better predictor of prostate cancer-specific mortality than the traditional three-tiered classification (low, intermediate, and high risk). We investigated radical treatment rates according to CPG in men diagnosed with non-metastatic prostate cancer in England between 2014 and 2017.

methodsPatients diagnosed with non-metastatic prostate cancer were identified from the National Prostate Cancer Audit database. Men were risk stratified according to the CPG classification. Risk ratios (RR) were estimated for undergoing radical treatment according to CPG and for receiving radiotherapy for those treated radically. Funnel plots were used to display variation in radical treatment rates across hospitals.

resultsA total of 61,999 men were included with 10,963 (17.7%) in CPG1 (lowest risk group), 13,588 (21.9%) in CPG2, 9452 (15.2%) in CPG3, 12,831 (20.7%) in CPG4, and 15,165 (24.5%) in CPG5 (highest risk group). The proportion of men receiving radical treatment increased from 11.3% in CPG1 to 78.8% in CGP4, and 73.3% in CPG5. Men in CPG3 were more likely to receive radical treatment than men in CPG2 (66.3% versus 48.4%; adjusted RR 1.44; 95% CI 1.36-1.53; P < 0.001). Radically treated men in CPG3 were also more likely to receive radiotherapy than men in CPG2 (59.2% versus 43.9%; adjusted RR, 1.18; 95% CI 1.10-1.26). Although radical treatment rates were similar in CPG4 and CPG5 (78.8% versus 73.3%; adjusted RR 1.01; 95% CI 0.98-1.04), more men in CPG5 had radiotherapy than men in CPG4 (79.9% versus 59.1%, adjusted RR 1.26; 95% CI 1.12-1.40).

conclusionsThe CPG classification distributes men in five risk groups that are about equal in size. It reveals differences in treatment practices in men with intermediate-risk disease (CPG2 and CPG3) and in men with high-risk disease (CPG4 and CPGP5) that are not visible when using the traditional three-tiered risk classification.

Indexed as

AgedAged, 80 and overHumansMaleMiddle AgedPrognosisProstatic NeoplasmsRisk FactorsCambridge Prognostic GroupsCPGNon-metastatic diseaseProstate cancerRisk stratificationTreatment selection

Identifiers

PMID32460859
PMCPMC7254634

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.