Abstract
BackgroundPancreatic head ductal adenocarcinoma (PHDAC) patients with the same tumor-node-metastasis (TNM) stage may share different outcomes after pancreaticoduodenectomy (PD). Therefore, a novel method to identify patients with poor prognosis after PD is urgently needed. We aimed to develop a nomogram to estimate survival in PHDAC after PD.MethodsTo estimate survival after PD, a nomogram was developed using the Tongji Pancreatic cancer cohort comprising 355 PHDAC patients who underwent PD. The nomogram was validated under the same conditions in another cohort (N = 161) from the National Taiwan University Hospital. Prognostic factors were assessed using LASSO and multivariate Cox regression models. The nomogram was internally validated using bootstrap resampling and then externally validated. Performance was assessed using concordance index (c-index) and calibration curve. Clinical utility was evaluated using decision curve analysis (DCA), X-tile program, and Kaplan–Meier curve in both training and validation cohorts.ResultsOverall, the median follow-up duration was 32.17 months, with 199 deaths (64.82%) in the training cohort. Variables included in the nomogram were age, preoperative CA 19-9 levels, adjuvant chemotherapy, Tongji classification, T stage, N stage, and differentiation degree. Harrell’s c-indices in the internal and external validation cohorts were 0.79 (95% confidence interval [CI], 0.76–0.82) and 0.83 (95% CI, 0.78–0.87), respectively, which were higher than those in other staging systems. DCA showed better clinical utility.ConclusionThe nomogram was better than TNM stage and Tongji classification in predicting PHDAC patients’ prognosis and may improve prognosis-based selection of patients who would benefit from PD.
Highlights
Pancreatic head ductal adenocarcinoma (PHDAC) is one of the most lethal cancers of the digestive system [1, 2]
In the eighth American Joint Commission on Cancer (AJCC) stage, PHDAC with the celiac axis, superior mesenteric artery (SMA), and/or common hepatic artery involved was defined as being in the T4 stage, which failed to demonstrate the situation of superior mesenteric vein/portal vein (SMV/PV) invasion
All patients admitted to our surgical department would first receive an assessment of surgical resectability by the multidisciplinary team (MDT) through imaging to ascertain as curatively resectable pancreatic ductal adenocarcinoma (PDAC) preoperatively, even with peripancreatic invasion or artery or vein that could be completely resected and reconstructed
Summary
Pancreatic head ductal adenocarcinoma (PHDAC) is one of the most lethal cancers of the digestive system [1, 2]. Tumor-node-metastasis (TNM) staging is a widely used predictive system to guide surgical intervention and indicate postoperative prognosis in PHDAC [8], its derived American Joint Commission on Cancer (AJCC) clinical staging system and the Japanese Pancreas Society (JPS) classification. The Tongji classification (TJC) is an efficient classification system to indicate the vasculature and the choice of surgical approach [13] It is a good supplement of AJCC stage to guide upfront treatment of PHDAC. Pancreatic head ductal adenocarcinoma (PHDAC) patients with the same tumor-node-metastasis (TNM) stage may share different outcomes after pancreaticoduodenectomy (PD). We aimed to develop a nomogram to estimate survival in PHDAC after PD
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