Abstract
BackgroundLiver metastasis is an important prognostic factor for pancreatic neuroendocrine neoplasms (pNENs), but the relationship between the clinical features of patients with pNEN and liver metastasis remains undetermined. The aim of this study was to establish and validate an easy-to-use nomogram to predict liver-metastasis in patients with pNEN.MethodsWe obtained the clinicopathologic data of 2960 patients with pancreatic neuroendocrine neoplasms from the Surveillance, Epidemiology and End Results (SEER) database between 2010 and 2016. Univariate and multivariate logistic regression were done to screen out independent influencing factors to establish the nomogram. The calibration plots and the area under the receiver operating characteristic curve (AUC) were used to evaluate the performance of nomogram. Decision curve analysis (DCA) was applied to compare the novel model with the conventional predictive methods.ResultsA total of 2960 patients with pancreatic neuroendocrine neoplasms were included in the study. Among these, 1974 patients were assigned to the training group and 986 patients to the validation group. Multivariate logistic regression identified, tumor size, grade, other site metastasis, T stage and N stage as independent risk factors. The calibration plot showed good discriminative ability in the training and validation groups, with C-indexes of 0.850 for the training cohort and 0.846 for the validation cohort. The AUC values were 0.850 (95% CI 0.830–0.869) and 0.839 (95% CI 0.812–0.866), respectively. The nomogram total points (NTP) had the potential to stratify patients into low risk, medium risk and high risk (P < 0.001). Finally, comparing the nomogram with traditional prediction methods, the DCA curve showed that the nomogram had better net benefit.ConclusionsOur nomogram has a good ability to predict liver metastasis of pancreatic neuroendocrine neoplasms, and it can guide clinicians to provide suitable prevention and treatment measures for patients with medium- and high-risk liver metastasis.
Highlights
Liver metastasis is an important prognostic factor for pancreatic neuroendocrine neoplasms, but the relationship between the clinical features of patients with Pancreatic neuroendocrine neoplasms (pNEN) and liver metastasis remains undetermined
Early diagnosis and treatment of pNEN patients with liver metastases can significantly improve the quality of life and prognosis
To further discriminate the risk groups of liver metastasis, the patients were categorized into low, medium- and high-risk groups based on the nomogram total points (NTP) of every pNEN patients
Summary
Liver metastasis is an important prognostic factor for pancreatic neuroendocrine neoplasms (pNENs), but the relationship between the clinical features of patients with pNEN and liver metastasis remains undetermined. It is reported that more than 60% of patients with pNEN have liver metastases [3]. Studies have found that liver metastasis is an important risk factor for prognosis [4]. The treatment strategy and prognosis of pNEN largely depend on whether there is liver metastasis. Early diagnosis and treatment of pNEN patients with liver metastases can significantly improve the quality of life and prognosis. Due to the lack of typical clinical manifestations of nonfunctional pNEN in the early stage, 20% to 30% of pNEN patients have liver metastases when diagnosed, which seriously affects their quality of life and long-term survival [5, 6]. It is critical that clinicians accurately identify the risk of liver metastases in patients with pNEN for optimal treatment strategies
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