Systematic review of clinical prediction models for survival after surgery for resectable pancreatic cancer

Abstract

Background: As more therapeutic options for pancreatic cancer are becoming available, there is a need to improve outcome prediction to support shared decision-making. A systematic evaluation of prediction models in resectable pancreatic cancer is lacking.Methods: This systematic review followed the CHARMS and PRISMA guidelines. PubMed, Embase and Cochrane Library databases were searched up to 11 October 2017. Studies reporting development or validation of models predicting survival in resectable pancreatic cancer were included. Models without performance measures, reviews, abstracts or more than 10 per cent of patients not undergoing resection in postoperative models were excluded. Studies were appraised critically.Results: After screening 4403 studies, 22 (44 319 patients) were included. There were 19 model development/update studies and three validation studies, altogether concerning 21 individual models. Two studies were deemed at low risk of bias. Eight models were developed for the preoperative setting and 13 for the postoperative setting. Most frequently included parameters were differentiation grade (11 of 21 models), nodal status (8 of 21) and serum albumin (7 of 21). Treatment-related variables were included in three models. The C-statistic/area under the curve values ranged from 0⋅57 to 0⋅90. Based on study design, validation methods and the availability of web-based calculators, two models were identified as the most promising. Conclusion: Although a large number of prediction models for resectable pancreatic cancer have been reported, most are at high risk of bias and have not been validated externally. This overview of prognostic factors provided practical recommendations that could help in designing easily applicable prediction models to support shared decision-making.Prediction models enable clinicians and patients to calculate the risks of a specific endpoint individualized to a patient, using combinations of predictors. Such models are used widely in some fields, including the CHADS 2 -VASc score for estimation of stroke risk in atrial fibrillation 3 , and the Acute Physiology and Chronic Health Evaluation (APACHE) score 4 for mortality in intensive care. In breast cancer, the PREDICT 5 and Adjuvant! 6 models have been employed in the decision-making process to determine adjuvant treatment administration. Data analysisData extraction was performed independently by two authors. Articles were categorized into development/model update studies and validation studies 12 .

Clinical characteristics and blood/serum bound prognostic biomarkers in advanced pancreatic cancer treated with gemcitabine and nab-paclitaxel

“…However, the present data are consistent with previous reports on long term survival in patients with earlier stages of pancreatic cancer who underwent pancreatic resection [10]. Serum albumin is often considered a surrogate marker for nutritional status, 'general fitness', and ability to recover following major abdominal surgery, and has been assessed in numerous trials on resectable pancreatic cancer (reviewed in [11]). The present study implies that serum albumin may be additionally useful as a prognostic marker in the palliative setting, in terms of predicting survival in patients commencing first line Gem/NabP palliative chemotherapy.…”

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

“…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. 14 Moreover, age was also incorporated in the prediction model because of its relation with CS.…”

“…Although some might argue that a C-statistic of 0.65 is relatively low, it is in line with previous prediction models in pancreatic cancer. 23 The difficulty in accurately Each column represents the years survived from surgery and each row represents the percentage to reach a certain total survival time from that point of survived years. For example, if a patient has survived 2 years after surgery, the probability to be alive at 3 years after surgery is 68% and to achieve 5-year survival after surgery is 42%.…”

Clinical characteristics and blood/serum bound prognostic biomarkers in advanced pancreatic cancer treated with gemcitabine and nab-paclitaxel

“…Serum albumin is often considered a surrogate marker for nutritional status, 'general tness', and ability to recover following major abdominal surgery, and has been assessed in numerous trials on resectable pancreatic cancer (reviewed in [11]). The present study implies that serum albumin may be additionally useful as a prognostic marker in the palliative setting, in terms of predicting survival in patients commencing rst line Gem/NabP palliative chemotherapy.…”