Abstract
Background: Currently, proposed nomograms are mainly based on post-operative histopathology. The purpose of this study was to identify preoperative computed tomography (CT) and clinical information that allow prediction of disease-free (DFS) and overall survival (OS) of patients surgically treated for pancreatic head cancer. Methods: A total of 136 patients who underwent curative-intent surgery were retrospectively reviewed. Based on results from multivariate Cox regression analysis, a prediction model was constructed with preoperative CT features and clinical information. Overall performance of the nomogram was calculated by Harrell’s C-index. Results: Symptoms at diagnosis, preoperative serum CA 19-9 ≥ 34 U/mL, and four imaging features (necrosis (DFS, P = 0.066; OS, P = 0.002), possible venous invasion (DFS, P = 0.150, OS, P = 0.055), suspected metastatic regional lymph node (DFS, P = 0.001; OS, P = 0.099), and associated pancreatitis or pseudocyst (DFS, P = 0.013; OS, P = 0.041)) were included to build the nomogram. The c-statistics for the discrimination power of the proposed nomogram was 0.6496 for DFS and 0.6746 for OS. Conclusion: A nomogram derived from preoperative CT and clinical information could estimate the risk of recurrence and all-cause death after curative-intent surgery for radiologically resectable pancreatic head cancer.
Highlights
Pancreatic cancer is the fourth leading cause of cancer-related mortality [1]
The nomogram included six preoperative parameters: Presence of symptoms at diagnosis, preoperative serum CA 19-9 dichotomized at 34 U/mL, necrosis on computed tomography (CT), PV or SMV invasion on CT, presence of suspected metastatic regional lymph node (LN) on CT, and associated pancreatitis or pseudocyst on CT (Figure 2)
A nomogram based on preoperative clinical and radiologic parameters was derived to predict postoperative oncologic outcomes of patients with pancreatic head cancer who underwent curative-intent surgery without neoadjuvant therapy. It included symptoms at diagnosis, preoperative serum CA 19-9 dichotomized at 34 U/mL, and four CT features to predict oneand five-year disease-free survival (DFS) and overall survival (OS)
Summary
Pancreatic cancer is the fourth leading cause of cancer-related mortality [1] Because it tends to be detected in advanced stages, only 20% of newly diagnosed patients are thought to be surgical candidates [2]. Half of patients who undergo curative-intent surgery for pancreatic cancer experience recurrence within a year [8,9]. The purpose of this study was to identify preoperative computed tomography (CT) and clinical information that allow prediction of disease-free (DFS) and overall survival (OS) of patients surgically treated for pancreatic head cancer. Conclusion: A nomogram derived from preoperative CT and clinical information could estimate the risk of recurrence and all-cause death after curative-intent surgery for radiologically resectable pancreatic head cancer
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