International validation and update of the Amsterdam model for prediction of survival after pancreatoduodenectomy for pancreatic cancer

Roessel, Stijn van; Strijker, Marin; Groen, Jesse V.; Mieog, J. Sven D.; Groot, Vincent P.; He, Jin; Pastena, Matteo De; Marchegiani, Giovanni; Bassi, Claudio; Suhool, Amal; Jang, Jin Young; Busch, Olivier R.; Halimi, Asif; Zarantonello, Laura; Koerkamp, Bas Groot; Samra, Jaswinder S.; Mittal, Anubhav; Gill, Anthony J.; Bolm, Louisa; Eijck, Casper H. van; Hilal, Mohammed Abu; Chiaro, Marco Del; Keck, Tobias; Wolfgang, Christopher L.; Malleo, Giuseppe; Besselink, Marc G.

doi:10.1016/j.ejso.2019.12.023

Cited by 15 publications

(20 citation statements)

References 23 publications

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“…Due to these weak correlations, a cohort size of nearly 8000 patients was necessary to establish statistical significance [9]. In contrast, in the present study, the HR for CTCs was 3.7 (95% CI 1.7-8.3, p=.001), exhibiting a strength of correlation commonly found for histopathologial factors [26,27]. Comparing the prediction strength, patients falling into the high-risk group of the PDAC-nomogram had a predicted median OS of less than 1.5 years, while the present study shows a median CSS of 6.63 months for CTC-positive patients, indicating a stronger survival impact by CTCs.…”

Section: Discussioncontrasting

confidence: 69%

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Preoperative CTC-Detection by Cell-Search® Is Associated With Early Distant Metastasis and Impaired Survival in Resected Pancreatic Cancer

Hugenschmidt¹,

Labori²,

Borgen³

et al. 2020

Preprint

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In patients with presumed pancreatic ductal adenocarcinoma (PDAC), biomarkers that may open for personalised, risk-adapted treatment are lacking. The study analysed the impact of circulating tumour cells (CTCs) on the patterns of recurrence and survival in 98 patients resected for PDAC with 5-10 years of follow-up. Preoperative samples were analysed by the CellSearch® system for EpCAM+/DAPI+/CK+/CD45- CTCs. CTCs were detected in 7 of the 98 patients. CTCs predicted a significantly shorter median DFS of 3.3 vs. 9.2 months and a median CSS of 6.3 vs. 18.5 months. Relapse status was confirmed by imaging for 87 patients. Of these, 58 developed distant metastases (DM) and 29 cases isolated local recurrence (ILR) as first event. All patients with CTCs experienced DM. pN-status and histological grade &gt;2 were other independent risk factors for DM, but only CTCs predicted significantly shorter cancer-specific, disease-free and post-recurrence survival. We conclude that CTC presence in resected PDAC patients predicted early distant metastasis and impaired survival. The impact of CTCs was comparable to that of histopathological risk factors and exceeded the effect size of other preoperative parameters. Thus, preoperative CTCs alone or in combination with histopathological factors may guide initial treatment decisions in patients with resectable PDAC in the future.

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Section: Discussioncontrasting

confidence: 69%

“…However, "in-between study comparisons" should be interpreted with caution. For postoperative prediction, the Amsterdam model [27], with its recent update [26] achieves excellent survival prediction. This was obtained by combining histopathological factors together with information about the completion of adjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

Preoperative CTC-Detection by Cell-Search® Is Associated With Early Distant Metastasis and Impaired Survival in Resected Pancreatic Cancer

Hugenschmidt¹,

Labori²,

Borgen³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…To develop a nomogram predicting 5-year survival, the predictors of the previously published and externally validated Amsterdam model were used. 14,22 This model was used because of its simplicity and methodological quality according to a recent systematic review and to maintain consistency with previous studies. 14,23 The Amsterdam model uses adjuvant chemotherapy, margin status, tumor differentiation, and lymph node ratio to predict overall survival for patients who underwent pancreatoduodenectomy for pancreatic cancer.…”

Section: Discussionmentioning

confidence: 99%

Conditional Survival After Resection for Pancreatic Cancer: A Population-Based Study and Prediction Model

et al. 2020

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Background. Conditional survival is the survival probability after already surviving a predefined time period. This may be informative during follow-up, especially when adjusted for tumor characteristics. Such prediction models for patients with resected pancreatic cancer are lacking and therefore conditional survival was assessed and a nomogram predicting 5-year survival at a predefined period after resection of pancreatic cancer was developed.Methods. This population-based study included patients with resected pancreatic ductal adenocarcinoma from the Netherlands Cancer Registry (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016). Conditional survival was calculated as the median, and the probability of surviving up to 8 years in patients who already survived 0-5 years after resection was calculated using the Kaplan-Meier method. A prediction model was constructed. Results. Overall, 3082 patients were included, with a median age of 67 years. Median overall survival was 18 months (95% confidence interval 17-18 months), with a 5-year survival of 15%. The 1-year conditional survival (i.e. probability of surviving the next year) increased from 55 to 74 to 86% at 1, 3, and 5 years after surgery, respectively, while the median overall survival increased from 15 to 40 to 64 months at 1, 3, and 5 years after surgery, respectively. The prediction model demonstrated that the probability of achieving 5-year survival at 1 year after surgery varied from 1 to 58% depending on patient and tumor characteristics.Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08235-w) contains supplementary material, which is available to authorized users.

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“…For example, in oncological liver surgery, one would like to have a system that combines patient information (laboratory results, imaging, comorbidities, and previous surgeries) with evidence-based information (scientific publications) and surgical experience (the clinical course of previously treated patients) to avoid post-hepatectomy liver failure or to choose the optimal multimodal treatment. Similarly, AI may help to improve systems of predictive analytics that estimate survival after pancreatoduodenectomy for pancreatic cancer [47] or secondary effects of surgery, such as incisional hernia [48].…”

Section: Potential Effects Of Ai In Surgerymentioning

confidence: 99%

Artificial Intelligence-Assisted Surgery: Potential and Challenges

et al. 2020

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Background: Artificial intelligence (AI) has recently achieved considerable success in different domains including medical applications. Although current advances are expected to impact surgery, up until now AI has not been able to leverage its full potential due to several challenges that are specific to that field. Summary: This review summarizes data-driven methods and technologies needed as a prerequisite for different AI-based assistance functions in the operating room. Potential effects of AI usage in surgery will be highlighted, concluding with ongoing challenges to enabling AI for surgery. Key Messages: AI-assisted surgery will enable data-driven decision-making via decision support systems and cognitive robotic assistance. The use of AI for workflow analysis will help provide appropriate assistance in the right context. The requirements for such assistance must be defined by surgeons in close cooperation with computer scientists and engineers. Once the existing challenges will have been solved, AI assistance has the potential to improve patient care by supporting the surgeon without replacing him or her.

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International validation and update of the Amsterdam model for prediction of survival after pancreatoduodenectomy for pancreatic cancer

Cited by 15 publications

References 23 publications

Preoperative CTC-Detection by Cell-Search® Is Associated With Early Distant Metastasis and Impaired Survival in Resected Pancreatic Cancer

Preoperative CTC-Detection by Cell-Search® Is Associated With Early Distant Metastasis and Impaired Survival in Resected Pancreatic Cancer

Conditional Survival After Resection for Pancreatic Cancer: A Population-Based Study and Prediction Model

Artificial Intelligence-Assisted Surgery: Potential and Challenges

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