Abstract
Background: Total pancreatectomy (TP) seems to be experiencing a renaissance in recent years. In this study, we aimed to determine the long-term survival of pancreatic ductal adenocarcinoma (PDAC) patients who underwent TP by comparing with pancreaticoduodenectomy (PD), and formulate a nomogram to predict overall survival (OS) for PDAC individuals following TP.Methods: Patients who were diagnosed with PDAC and received PD (n = 5,619) or TP (n = 1,248) between 2004 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. OS and cancer-specific survival (CSS) of the PD and TP groups were compared using Kaplan-Meier method and log-rank test. Furthermore, Patients receiving TP were randomly divided into the training and validation cohorts. Univariate and multivariate Cox regression were applied to identify the independent factors affecting OS to construct the nomogram. The performance of the nomogram was measured according to concordance index (C-index), calibration plots, and decision curve analysis (DCA).Results: There were no significant differences in OS and CSS between TP and PD groups. Age, differentiation, AJCC T stage, radiotherapy, chemotherapy, and lymph node ratio (LNR) were identified as independent prognostic indicators to construct the nomogram. The C-indexes were 0.67 and 0.69 in the training and validation cohorts, while 0.59 and 0.60 of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system. The calibration curves showed good uniformity between the nomogram prediction and actual observation. DCA curves indicated the nomogram was preferable to the AJCC staging system in terms of the clinical utility. A new risk stratification system was constructed which could distinguish patients with different survival risks.Conclusions: For PDAC patients following TP, the OS and CSS are similar to those who following PD. We developed a practical nomogram to predict the prognosis of PDAC patients treated with TP, which showed superiority over the conventional AJCC staging system.
Highlights
A total of 6,867 patients with Pancreatic ductal adenocarcinoma (PDAC) were screened from the SEER database from 2004 to 2015
We formulated a nomogram which could effectively forecast the 1, 3, and 5-year overall survival (OS) of PDAC patients treated with total pancreatectomy (TP), which might be helpful for clinicians to better grasp their patients’ prognostic results
It was previously thought that TP was associated poorer long-term survival compared with PD [7, 14], but several studies have argued that the long-term survival of PDAC patients following TP vs. PD was equivalent [11, 12, 30]
Summary
Pancreatic ductal adenocarcinoma (PDAC) is the most common histopathological type and has almost been synonymous with pancreatic cancer [2]. There are three main surgical approaches for PDAC generally based on the location of the lesion, pancreaticoduodenectomy (PD), distal pancreatectomy (DP) and total pancreatectomy (TP). While PD and DP have been common surgical approaches with confirmed short- and long-term outcomes [3, 4], the role of TP in the treatment of PDAC remains controversial. We aimed to determine the long-term survival of pancreatic ductal adenocarcinoma (PDAC) patients who underwent TP by comparing with pancreaticoduodenectomy (PD), and formulate a nomogram to predict overall survival (OS) for PDAC individuals following TP
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