Prognostic nomogram and score to predict overall survival in locally advanced untreated pancreatic cancer (PROLAP)

Abstract

Background:The management of locally advanced pancreatic cancer (LAPC) patients remains controversial. Better discrimination for overall survival (OS) at diagnosis is needed. We address this issue by developing and validating a prognostic nomogram and a score for OS in LAPC (PROLAP).Methods:Analyses were derived from 442 LAPC patients enrolled in the LAP07 trial. The prognostic ability of 30 baseline parameters was evaluated using univariate and multivariate Cox regression analyses. Performance assessment and internal validation of the final model were done with Harrell's C-index, calibration plot and bootstrap sample procedures. On the basis of the final model, a prognostic nomogram and a score were developed, and externally validated in 106 consecutive LAPC patients treated in Besançon Hospital, France.Results:Age, pain, tumour size, albumin and CA 19-9 were independent prognostic factors for OS. The final model had good calibration, acceptable discrimination (C-index=0.60) and robust internal validity. The PROLAP score has the potential to delineate three different prognosis groups with median OS of 15.4, 11.7 and 8.5 months (log-rank P<0.0001). The score ability to discriminate OS was externally confirmed in 63 (59%) patients with complete clinical data derived from a data set of 106 consecutive LAPC patients; median OS of 18.3, 14.1 and 7.6 months for the three groups (log-rank P<0.0001).Conclusions:The PROLAP nomogram and score can accurately predict OS before initiation of induction chemotherapy in LAPC-untreated patients. They may help to optimise clinical trials design and might offer the opportunity to define risk-adapted strategies for LAPC management in the future.

Prediction of overall survival for metastatic pancreatic cancer: Development and validation of a prognostic nomogram with data from open clinical trial and real‐world study

“…The identification of different risk groups with different potential outcome may offer the opportunity to select risk‐adapted strategies for MPC. In addition, using this nomograms, patients with MPC can be evaluated and stratified in clinical trials to reduce heterogeneity among different treatment arms …”

“…Up to date, various kinds of prognostic models were reported in pancreatic cancer (Table ) . Overall, there were 3 common types of models: nomogram, models based on the regression coefficient of prognostic factors and models based on the number of prognostic factors.…”

“…The most widely used prognostic factors in these models included age, sex, tumor size, performance status, regional lymph node metastasis, distant metastasis, carbohydrate antigen 19‐9 (CA19‐9), and back pain. Moreover, several nomograms were constructed in pancreatic cancer with different stages . However, most of them were based on retrospective data and none of them mainly focused on metastatic pancreatic cancer (MPC).…”

“…6 Up to date, various kinds of prognostic models were reported in pancreatic cancer (Table S1). [7][8][9][10][11][12][13][14][15] Overall, there were 3 common types of models: nomogram, models based on the regression coefficient of prognostic factors and models based on the number of prognostic factors. It seems that only nomogram can provide a valid clinical outcome for each patient and is gradually used in evaluating cancer prognosis.…”

Long-Term Outcomes and Prognostic Factors in Advanced Gallbladder Cancer: Focus on the Advanced T Stage

“…Patients with advanced GBC sometimes develop cholangitis or treatment-resistant cholecystitis, which may result in hypoalbuminemia [37]. Albumin is one of the independent prognostic factors for overall survival in other cancers such as pancreatic cancer and gastric cancer [38,39]. Therefore, preoperative ultrasound examination and correcting hypoalbuminemia are very important.…”