A preoperative nomogram predicts prognosis of up front resectable patients with pancreatic head cancer and suspected venous invasion

Abstract

Background: Pancreatic head adenocarcinoma is commonly diagnosed at an advanced stage when adjacent vascular invasion is present. This study aimed to establish a preoperative prognostic nomogram for patients who underwent attempted curative resectional surgery for pancreatic head cancer with suspected peripancreatic venous invasion. Methods: The data on all consecutive patients who underwent attempted curative resectional surgery for pancreatic head cancer with suspected peripancreatic venous invasion were retrospectively collected from 2012 to 2016 at 4 academic institutions in China. The demographic and radiological parameters were analyzed using univariate and multivariate Cox regression analyses. The final nomogram was established using the concordance Harrell's C-indices and calibration curves from data obtained in 3 institutions and validated in the cohort of patients coming from the fourth institution. Results: The nomogram was constructed using data from 178 patients while the validation cohort consisted of 61 patients. Seven imaging features on computed tomography showing peripancreatic venous abnormalities were identified and they were classified into 4 types. Age, length of tumor contact, peripancreatic venous abnormalities and Lymph node staging were independent factors of overall survival. The nomogram showed good probabilities of survival on calibration curves. The C-index of the model in predicting overall survival (OS) was 0.824 for the validation cohort. The correlation between the radiographic and pathologic findings was high. Conclusions: The nomogram accurately predicted OS in patients with pancreatic head cancer with suspected peripancreatic venous invasion after attempted curative pancreatic resectional surgery.