A Novel Prediction Tool Based on Large Cohorts to Determine the Cancer-Specific Survival Probability of Patients With Locally Advanced Pancreatic Cancer After Irreversible Electroporation Treatment.

Chaobin He,Yu Zhang,Xin Huang,Shengping Li,Xiaojun Lin

doi:10.3389/fonc.2020.00952

Abstract

Irreversible electroporation (IRE) is a novel method which was especially suitable for the treatment of locally advanced pancreatic cancer (LAPC). The purpose of this study was to evaluate probabilities of overall survival (OS) and cancer-specific survival (CSS) in patients with LAPC after IRE treatment and to construct nomograms to predict survival for these patients. Data of patients were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database and medical records of Sun Yat-sen University Cancer Center (SYSUCC). A total of 312 LAPC patients after IRE treatment were included into this study. The 3-year cumulative incidence of cancer-specific mortality for patients with LAPC after IRE treatment was 74.3%. Nomograms for predicting probabilities of OS, CSS, and non-cancer-specific survival (NCSS) were built and calibrated with the concordance index (C-index) and the area under receiver operating characteristic (ROC) curve (AUC). The established nomograms were well-calibrated, with C-indexes of 0.782 for OS prediction, 0.729 for CSS prediction, and 0.730 for NCSS prediction. Compared with the TNM stage system, the established nomograms displayed higher values of AUC and showed better discriminatory power for predicting OS, CSS, and NCSS. These nomograms were well-calibrated and could serve to guide management of LAPC patients after IRE treatment.

Highlights

Pancreatic cancer (PC) is the second most common gastrointestinal malignancy and the fourth leading cause of cancer death worldwide [1]
The management of Locally advanced pancreatic cancer (LAPC) patients foresees the use of gemcitabine based on chemotherapy in association or not with radiotherapy, achieving marginal benefits in terms of elevating overall survival
We identified 237 eligible LAPC patients who had received Irreversible electroporation (IRE) treatment from the SEER database

Summary

Introduction

Pancreatic cancer (PC) is the second most common gastrointestinal malignancy and the fourth leading cause of cancer death worldwide [1]. The management of LAPC patients foresees the use of gemcitabine based on chemotherapy in association or not with radiotherapy, achieving marginal benefits in terms of elevating overall survival. Such multimodality therapy can only downstage a small proportion of patients to resectable diseases. Patients with unresectable LAPC own a poor median survival of only 6–11.5 months in most of prospective clinical trials despite advances in chemotherapy, radiotherapy, and chemoradiotherapy [7, 8] In this term, apart from systemic chemotherapy and radiation therapy, a new therapy method should be explored to improve the prognosis of LAPC patients

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Conclusion