Development of Nomograms for Predicting Prognosis of Pancreatic Cancer after Pancreatectomy: A Multicenter Study

Abstract

Surgical resection is the only curative treatment for pancreatic ductal adenocarcinoma (PDAC). Currently, the TNM classification system is considered the standard for predicting prognosis after surgery. However, the prognostic accuracy of the system remains limited. This study aimed to develop new predictive nomograms for resected PDAC. The clinicopathological data of patients who underwent surgery for PDAC between 2006 and 2015 at five major institutions were retrospectively reviewed; 885 patients were included in the analysis. Cox regression analysis was performed to investigate prognostic factors for recurrence and survival, and statistically significant factors were used for creating nomograms. The nomogram for predicting recurrence-free survival included nine factors: sarcopenic obesity, elevated carbohydrate antigen 19–9, platelet-to-lymphocyte ratio, preoperatively-identified arterial abutment, estimated blood loss (EBL), tumor differentiation, size, lymph node ratio, and tumor necrosis. The nomogram for predicting overall survival included 10 variables: age, underlying liver disease, chronic kidney disease, preoperatively found portal vein invasion, portal vein resection, EBL, tumor differentiation, size, lymph node metastasis, and tumor necrosis. The time-dependent area under the receiver operating characteristic curve for both nomograms exceeded 0.70. Nomograms were developed for predicting survival after resection of PDAC, and the platforms showed fair predictive performance. These new comprehensive nomograms provide information on disease status and are useful for determining further treatment for PDAC patients.

Factors affecting HPV infection in U.S. and Beijing females: A modeling study

“…Nomograms, as a reliable and convenient tool for individual risk prediction, have been widely used in the medical field and for guiding clinical decision ( 37 , 38 ). The C-index and AUC are the main reference for evaluating the predictive performance of a nomogram.…”

Construction and validation of a nomogram based on the log odds of positive lymph nodes to predict cancer-specific survival in patients with small cell lung cancer after surgery

“…These factors, including LODDS, age at diagnosis, sex, tumor size, and radiation status, were included in the final models. Based on the multivariate Cox proportional hazards regression model, a novel nomogram was generated to predict the CSS in patients with SCLC using the “rms” package [ 23 , 24 ].…”

Prognostic significance of preoperative lymphocytes, albumin, and neutrophils (LANR) index in resectable pancreatic ductal adenocarcinoma

“…In this study, we investigated the predictive value of 12 clinicopathologic variables (gender, age, tumor size, degree of differentiation, tumor location, TNM stage, lymph node metastasis, vascular cancer thrombus, peripheral nerve invasion, CEA, CA199, CA125) for resectable pancreatic ductal adenocarcinoma, and many attempts have been made to determine the prognostic factors of PDAC in addition to several well-known factors such as TNM stage and carbohydrate antigen 19 − 9 (CA19-9) [25],In several previous studies, LN status and degree of tumor differentiation were identified as prognostic factors for resectable PDAC [26][27][28],and these findings are consistent with the results of this study, which suggest that LN status and degree of differentiation are independent prognostic factors in patients with PDAC. In addition, studies have shown that neoadjuvant chemotherapy can inhibit tumor progression and effectively prolong postoperative survival [29].however, there is still a lack of uniform criteria for selecting patients who are candidates for neoadjuvant therapy.…”