Development and validation of a novel nomogram for predicting the prognosis of patients with resected pancreatic adenocarcinoma

Abstract

The survival prediction for patients with resected pancreatic adenocarcinoma by using the Tumor-Node-Metastasis (TNM) staging system remains limited. A nomogram is a efficient tool that can be used to predict the outcome of patients with various types of malignancy. The present study aimed to develop and validate a nomogram for patients with resected pancreatic adenocarcinoma. A total of 368 patients (258 in the training set and 110 in the validation set) who underwent pancreatic adenocarcinoma resection at the China National Cancer Center between January 2008 and October 2018 were included in the present study. The nomogram was established according to the results from Cox multivariate analysis, which was validated by discrimination and calibration. The area under the receiver operating characteristic curve (AUC) was determined to assess the accuracy of survival predictions. The results from multivariate analysis in the training set demonstrated that blood transfusion, T-stage, N-stage, tumor grade, capsule invasion, carbohydrate antigen 199, neutrophil percentage and adjuvant therapy were independent prognostic factors for overall survival (OS; all P<0.05). Subsequently, a nomogram predicting the 1-year, 3-year and 5-year OS rates, with favorable calibration, was established based on the independent prognostic factors. The concordance indices of the nomogram were higher compared with the TNM staging system in both training and validation sets. Furthermore, a clear risk stratification system based on the nomogram was used to classify patients into the three following groups: Low-risk group (≤168), moderate-risk group (168-255) and high-risk group (>255). The risk stratification system demonstrated an improved ability in predicting the 1-year, 3-year and 5-year OS rates compared with the TNM system (AUC, 0.758, 0.709 and 0.672 vs. AUC, 0.614, 0.604 and 0.568; all P<0.05). The present study developed and validated a nomogram for patients with resected pancreatic adenocarcinoma by including additional independent prognostic factors, including tumor marker, immune index, surgical information, pathological data and adjuvant therapy. Taken together, the results from the present study indicated an improved performance of the nomogram in predicting the prognosis of patients with resected pancreatic adenocarcinoma compared with the TNM staging system.

Development and validation of a network calculator model for safety and efficacy after pancreaticoduodenectomy in the elderly patients with pancreatic head cancer

“…With advances in therapeutic and paramedical approaches, the prognostic survival of pancreatic cancer patients who have undergone PD has been improved, with a 3-year OS rate of 41.4%. 32 For elderly patients, the 3-year CSS rate even goes up to 53.1% for pancreatic cancer patients above > = 70 years of age. 33 Although there were differences in the intensity of the association, the independent risk factors for OS and CSS in PHC patients were the same, namely, ASA score, history of diabetes, BMI, CA19-9 level, and maximum tumor diameter.…”

Pancreatic ductal adenocarcinoma with synchronous and metachronous hepatic metastasis predicted by contrast-enhanced ultrasound

“…CA19-9 is the only peripheral blood-based biomarker used to diagnose PDAC, but some studies (26,27) have concluded that this marker is not tumor-specific and is not suitable as a diagnostic biomarker for early metastases. However, some studies (28)(29)(30) have shown a possible correlation between CA19-9 ≥400 U/mL and hepatic metastasis. Meanwhile, other studies (27,31,32) have shown that the presence of circulating tumor cells (CTCs) in portal blood is associated with a higher rate of liver metastasis after resection of the primary tumor.…”

Proposal of nomograms to predict clinical outcomes in patients with ampulla of Vater cancer based on the Korea‐Japan collaborative study

“…Many studies have demonstrated the usefulness of nomograms 18–24 . In AOV cancer, as in other types of cancer, the only tool to predict the prognosis is the TNM staging system.…”

“…Many studies have demonstrated the usefulness of nomograms. [18][19][20][21][22][23][24] In AOV cancer, as in other types of cancer, the only tool to predict the prognosis is the TNM staging system. The biggest advantage of the nomogram is that it can predict the prognosis with various patient characteristics without limitations of the TNM staging system.…”