Abstract
BackgroundThe prognosis of patients with periampullary adenocarcinoma after pancreatoduodenectomy is diverse and not yet clearly illustrated. The aim of this study was to develop a nomogram to predict individual risk of overall survival (OS) and progression-free survival (PFS) in patients with periampullary adenocarcinoma after pancreatoduodenectomy.MethodsA total of 205 patients with periampullary adenocarcinoma after pancreatoduodenectomy were retrospectively included. OS and PFS were evaluated by the Kaplan-Meier method. Two nomograms for predicting OS and PFS were established, and the predictive accuracy was measured by the concordance index (Cindex) and calibration plots.ResultsLymph node ratio (LNR), carbohydrate antigen 19–9 (CA19–9) and anatomical location were incorporated into the nomogram for OS prediction and LNR, CA19–9; anatomical location and tumor differentiation were incorporated into the nomogram for PFS prediction. All calibration plots for the probability of OS and PFS fit well. The Cindexes of the nomograms for OS and PFS prediction were 0.678 and 0.68, respectively. The OS and PFS survival times were stratified significantly using the nomogram-predicted survival probabilities.ConclusionsThe present nomograms for OS and PFS prediction can provide valuable information for tailored decision-making for patients with periampullary adenocarcinoma after pancreatoduodenectomy.
Highlights
The prognosis of patients with periampullary adenocarcinoma after pancreatoduodenectomy is diverse and not yet clearly illustrated
Lymph node ratio (LNR), carbohydrate antigen 19–9 (CA19–9) and anatomical location were incorporated into the nomogram for overall survival (OS) prediction and LNR, CA19–9; anatomical location and tumor differentiation were incorporated into the nomogram for progression-free survival (PFS) prediction
Ampullectomy) (n = 5); (3) microscopic or macroscopic incomplete resection (n = 2); (4) patients diagnosed with distant metastasis with or without palliative therapy (n = 25); (5) pathologic cell types was not adenocarcinoma (n = 65); (6) patients diagnosed with other concurrent primary tumors (n = 12); (7) lost to follow-up (n = 18)
Summary
The prognosis of patients with periampullary adenocarcinoma after pancreatoduodenectomy is diverse and not yet clearly illustrated. The periampullary region is a complex region that is composed of distinct anatomical structures: the head of the pancreas, the distal common bile duct (CBD), the second portion of the duodenum, and the ampulla of Vater. The periampullary adenocarcinomas, including pancreatic head carcinoma, have a relatively low resectable rate of only 15–20% at diagnosis due to the absence of early detection methods [6, 7]. Patient survival after radical resection of adenocarcinomas of the pancreas, CBD, duodenum, and ampulla of Vater greatly varies [2, 8, 9], some studies have reported that there is a comparatively favorable prognosis among periampullary
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