title: 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)
creator: Lorent, Marine
creator: Maalmi, Haïfa
creator: Tessier, Philippe
creator: Supiot, Stéphane
creator: Dantan, Etienne
creator: Foucher, Yohann
subject: 610
subject: 610 Medical sciences Medicine
description: 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.
publisher: BioMed Central
date: 2019
type: Article
type: info:eu-repo/semantics/article
type: NonPeerReviewed
format: application/pdf
identifier: https://archiv.ub.uni-heidelberg.de/volltextserverhttps://archiv.ub.uni-heidelberg.de/volltextserver/25864/1/12911_2018_Article_727.pdf
identifier: DOI:
identifier: urn:nbn:de:bsz:16-heidok-258646
identifier:   Lorent, Marine ; Maalmi, Haïfa ; Tessier, Philippe ; Supiot, Stéphane ; Dantan, Etienne ; Foucher, Yohann  (2019) 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).  BMC Medical Informatics and Decision Making, 19 (2).  pp. 1-12.  ISSN 1472-6947     
relation: https://archiv.ub.uni-heidelberg.de/volltextserver/25864/
rights: info:eu-repo/semantics/openAccess
rights: Please see front page of the work (Sorry, Dublin Core plugin does not recognise license id)
language: eng