Abstract
ObjectiveThis study aimed to develop a nomogram to predict the 1-year survival of patients with pancreatic cancer who underwent pancreatectomy following neoadjuvant treatment with preoperatively detectable clinical parameters. Extended pancreatectomy is necessary to achieve complete tumor removal in borderline resectable and locally advanced pancreatic cancer. However, it increases postoperative morbidity and mortality rates, and should be balanced with potential benefit of long-term survival.MethodsThe medical records of patients who underwent pancreatectomy following neoadjuvant treatment from January 2005 to December 2016 at Severance Hospital were retrospectively reviewed. Medical records were collected from five international institutions from Japan and Singapore for external validation.ResultsA total of 113 patients were enrolled. The nomogram for predicting 1-year disease-specific survival was created based on 5 clinically detectable preoperative parameters as follows: age (year), symptom (no/yes), tumor size at initial diagnostic stage (cm), preoperative serum carbohydrate antigen (CA) 19-9 level after neoadjuvant treatment (<34/≥34 U/mL), and planned surgery [pancreaticoduodenectomy (PD) (pylorus-preserving PD)/distal pancreatectomy (DP)/total pancreatectomy]. Model performance was assessed for discrimination and calibration. The calibration plot showed good agreement between actual and predicted survival probabilities; the the Greenwood-Nam-D’Agostino (GND) goodness-of-fit test showed that the model was well calibrated (χ2=8.24, P=0.5099). A total of 84 patients were used for external validation. When correlating actual disease-specific survival and calculated 1-year disease-specific survival, there were significance differences according to the calculated probability of 1-year survival among the three groups (P=0.044). ConclusionsThe developed nomogram had quite acceptable accuracy and clinical feasibility in the decision-making process for the management of pancreatic cancer.
Highlights
Pancreatic cancer is among the most fatal cancers of the gastrointestinal tract
Surgical resection with clear safe margin is the only modality for curative treatment, only 20% of patients are eligible for surgical resection at the time of initial diagnosis because majority of patients are often diagnosed in the late stage and have poor general condition
We aimed to develop a nomogram to predict the 1-year survival of patients with pancreatic cancer who underwent pancreatectomy following neoadjuvant treatment with preoperatively detectable clinical parameters to provide a basis for decision-making for the appropriate management of pancreatic cancer following neoadjuvant treatment
Summary
Pancreatic cancer is among the most fatal cancers of the gastrointestinal tract. The overall 5-year survival rate of pancreatic cancer is only approximately 6%, and it is the fourth leading cause of cancer-related deaths in the United States [1] as well as in Korea [2]. When margin-negative resection is considered as the most effective treatment [6], extended pancreatectomy including combined major vascular resection and adjacent organ resection may be necessary to achieve complete tumor removal in borderline and locally advanced pancreatic cancers. Extended pancreatic resections following combined preoperative chemotherapy and radiotherapy before surgery are known to increase the rates of postoperative morbidity and mortality. Bhayani et al [11] analyzed 273 extended pancreatoduodenectomies from the National Surgical Quality Improvement Project database and reported a threefold increase in major perioperative morbidity and mortality rates even after adjusting for comorbidity in such surgical strategy. Hartwig et al [12] recently assessed the outcome of extended pancreatectomy for borderline resectable and locally advanced pancreatic cancer and showed that extended resections were associated with increased perioperative morbidity and mortality. We aimed to develop a nomogram to predict the 1-year survival of patients with pancreatic cancer who underwent pancreatectomy following neoadjuvant treatment with preoperatively detectable clinical parameters to provide a basis for decision-making for the appropriate management of pancreatic cancer following neoadjuvant treatment
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