Abstract
This study aimed to develop and validate an effective prognostic nomogram for advanced PDAC patients. We conducted a prospective multicenter cohort study involving 1,526 advanced PDAC patients from three participating hospitals in China between January 1, 2004 and December 31, 2013. Two thirds of the patients were randomly assigned to the training set (n = 1,017), and one third were assigned to the validation set (n = 509). Multivariate cox regression analysis was performed to identify significant prognostic factors for overall survival to develop the nomogram. Internal and external validation using C-index and calibration curve were conducted in the training set and validation set respectively. As results, seven independent prognostic factors were identified: age, tumor stage, tumor size, ALT (alanine aminotransferase), ALB (albumin), CA 19-9, HBV infection status, and these factors were entered into the nomogram. The proposed nomogram showed favorable discrimination and calibration both in the training set and validation set. The C-indexes of the training set and validation set were 0.720 and 0.696 respectively, which were both significantly higher than that of the staging system (C-index = 0.613, P < 0.001). In conclusion, the proposed nomogram may be served as an effective tool for prognostic evaluation of advanced PDAC.
Highlights
It is known that prognostic evaluation is the basis of personalized cancer treatment
Pancreatic ductal adenocarcinoma is heterogeneous in regard to survival of individual patients; prognostic evaluation solely based on the traditional staging system is imprecise
Despite several previously reported nomograms among PDAC patients, a nomogram has not been developed for Chinese advanced PDAC patients
Summary
It is known that prognostic evaluation is the basis of personalized cancer treatment. TNM staging system is one of the most widely used methods in the prognostic evaluation of cancer; it only takes histologic metastasis of tumor into account and doesn’t incorporate many other important prognostic factors, such as age, gender, tumor size, and tumor marker. In this sense, the traditional staging system is an inaccurate method for prognostic evaluation. Most of the proposed nomograms were constructed for specific population and derived from retrospectively collected data, so the clinical utility was limited In this setting, the current study aimed to develop and validate a widely applicable prognostic nomogram for advanced PDAC patients via a large prospective multicenter cohort study in China
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