Abstract
BackgroundPancreatic head adenocarcinoma (PHAC), a malignant tumour, has a very poor prognosis, and the existing prognostic tools lack good predictive power. This study aimed to develop a better nomogram to predict overall survival after resection of non-metastatic PHAC.MethodsPatients with non-metastatic PHAC were collected from the Surveillance, Epidemiology, and End Results (SEER) database and divided randomly into training and validation cohorts at a ratio of 7:3. Cox regression analysis was used to screen prognostic factors and construct the nomogram. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate the performance of the model. The predictive accuracy and clinical benefits of the nomogram were validated using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA).ResultsFrom 2010 to 2016, 6419 patients with non-metastatic PHAC who underwent surgery were collected from the SEER database. A model including T stage, N stage, grade, radiotherapy, and chemotherapy was constructed. The concordance index of the nomogram was 0.676, and the AUCs of the model assessing survival at multiple timepoints within 60 months were significantly higher than those of the American Joint Committee on Cancer (AJCC) 8th staging system in the training cohort. Calibration curves showed that the nomogram had ability to predict the actual survival. The NRI, IDI, and DCA curves also indicated that our nomogram had higher predictive capability and clinical utility than the AJCC staging system.ConclusionsOur nomogram has an ability to predict overall survival after resection of non-metastatic PHAC and includes prognostic factors that are easy to obtain in clinical practice. It would help assist clinicians to conduct personalized medicine.
Highlights
Pancreatic head adenocarcinoma (PHAC), a malignant tumour, has a very poor prognosis, and the existing prognostic tools lack good predictive power
Assessment of tumour prognosis primarily relies on the American Joint Committee on Cancer (AJCC) 8th edition staging system [8], which is based on the size and extent of the tumour, the number of metastatic lymph nodes, and the number of distant metastases
Some important prognostic factors are not taken into account in the AJCC staging system, such as age at diagnosis and tumour grade, which reduces its predictive accuracy for some patients
Summary
Pancreatic head adenocarcinoma (PHAC), a malignant tumour, has a very poor prognosis, and the existing prognostic tools lack good predictive power. This study aimed to develop a better nomogram to predict overall survival after resection of non-metastatic PHAC. Assessment of tumour prognosis primarily relies on the American Joint Committee on Cancer (AJCC) 8th edition staging system [8], which is based on the size and extent of the tumour, the number of metastatic lymph nodes, and the number of distant metastases. Several prognostic models have been developed to predict the prognosis of pancreatic body/tail tumours [10, 11], models of non-metastatic pancreatic head tumours still deserve to be explored further. A nomogram is needed to predict survival of patients after resection of non-metastatic PHAC and assist with treatment decision-making
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