Abstract
BackgroundThe aim of this study was to identify the determinants of overall survival (OS) within patients over 40 years old with surgically resected pancreatic carcinoma (PC), and to develop a nomogram with the intention of OS predicting.MethodsA total of 6341 patients of 40 years of age or later with surgically resected PC between 2010 and 2015 were enrolled from the Surveillance, Epidemiology, and End Results (SEER) program and randomly assigned into training set (4242 cases) and validation set (2099 cases). A nomogram was constructed for predicting 1-, 2- and 3-years OS based on univairate and multivariate Cox regression. The C-index and calibration plot were adopted to assess the nomogram performance.ResultsOur analysis showed that age, location of carcinoma in pancreas, tumor grade, TNM stage, size of carcinoma together with lymph node ratio (LNR) were considered to be independent overall survival predictors. A nomogram based on these six factors was developed with C-index being 0.680 (95%CI: 0.667–0.693). All calibration curves of OS fitted well. The OS curves stratified by nomogram-predicted probability score (≥20, 10–19 and < 10) demonstrated statistically significant difference not only within training set but also in validation set.ConclusionsThe present nomogram for OS predicting can serve as the efficacious survival-predicting model and assist in accurate decision-making for patients over 40 years old with surgically resected PC.
Highlights
The aim of this study was to identify the determinants of overall survival (OS) within patients over 40 years old with surgically resected pancreatic carcinoma (PC), and to develop a nomogram with the intention of OS predicting
Patient population Data of this study were retrieved from the SEER program, which covered up to 97% of incidence of cancer and encompassed 28% of the US population [17], and accessed by SEER*Stat software v. 8.3.5
Patients with elder age (HR = 1.328, 95% confidence interval (CI): 1.198–1.471), advanced grade (HR = 2.616 for moderately differentiated, 95% CI: 2.224–3.078; hazard ratio (HR) = 3.584 for poorly differentiated, 95% CI: 3.034–4.233; HR = 3.385 for undifferentiated, 95% CI: 2.371–4.832), advanced stage of TNM (HR = 1.855 for II stage, 95% CI: 1.542–2.231), enlarged carcinoma (HR = 1.303 for 2-4 cm, 95% CI: 1.136–1.494; HR = 1.512 for ≥4 cm, 95% CI: 1.307~1.749) and lymph node ratio (LNR) larger than 0.1732 (HR = 1.522, 95% CI: 1.388–1.669) suffered from more inferior survival
Summary
The aim of this study was to identify the determinants of overall survival (OS) within patients over 40 years old with surgically resected pancreatic carcinoma (PC), and to develop a nomogram with the intention of OS predicting. Pancreas carcinoma (PC), an extraordinarily common cancer, ranks as the fourth leading cause of cancer death in the western countries [1]. The morbidity and mortality of PC have been on the rise currently, and its morbidity shows a youth oriented tendency. Most of PC patients are older than 40 years of age. PC accounts for more than 200 000 deaths annually. It is anticipated to become the second dominating death cause in malign neoplasms by 2030 [2]. In spite of great progresses in surgery, neoadjuvant chemoradiotherapy and immunotherapy, PC prognosis still
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