Risk Factors, Prognostic Factors, and Nomograms for Distant Metastasis in Patients with Diagnosed Duodenal cancer: A Population- Based Study

Abstract

INTRODUCTION: Duodenal cancer is one of the most common subtypes of small intestinal cancer, and distant metastasis (DM) in this type of cancer still leads to poor prognosis. Although nomograms have recently been used in tumor areas, no studies have focused on the diagnostic and prognostic evaluation of DM in patients with primary duodenal cancer. Methods Data on duodenal cancer patients diagnosed between 2010 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for DM in patients with duodenal cancer, and univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors in duodenal cancer patients with DM. Two novel nomograms were established, and the results were evaluated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Result A total of 2,603 patients with duodenal cancer were included; and 457 patients (17.56%) had DM at the time of diagnosis. Independent risk factors for DM in patients with duodenal cancer include sex, grade, tumor size, T stage, and N stage. The independent prognostic factors for duodenal cancer patients with DM are age, histological type, T stage, tumor grade, tumor size, bone metastasis chemotherapy, and surgery. The results of ROC curves, calibration, DCA, and Kaplan–Meier (K-M) survival curves in the training, validation, and expanded testing sets confirmed that the two nomograms could precisely predict the occurrence and prognosis of DM in patients with duodenal cancer. Conclusion two nomograms are expected to be effective tools for predicting the risk of DM in patients with duodenal cancer and personalized prognosis prediction for patients with DM, which may benefit clinical decision-making.