Score for the Overall Survival Probability of Patients With Pancreatic Adenocarcinoma of the Body and Tail After Surgery: A Novel Nomogram-Based Risk Assessment.

Chaobin He,Shuxin Sun,Shengping Li,Xiaojun Lin,Yu Zhang

doi:10.3389/fonc.2020.00590

Abstract

Pancreatic adenocarcinoma of the body and tail often has a dismal prognosis and lacks a specific prognostic stage. The aim of this study was to construct a nomogram for predicting survival of patients with pancreatic adenocarcinoma of the body and tail after surgery. Data of patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database and from medical records of Sun Yat-sen University Cancer Center (SYSUCC). In a multivariate analysis for overall survival (OS), the following six variables were identified as independent predictors and incorporated into the nomogram: age, tumor differentiation, tumor size, lymph node ratio (LNR), and chemotherapy. A nomogram was built based on independent risk predictors. The concordance index (C-index) for nomogram, Tumor-Node-Metastasis (TNM) 7th and 8th stage system were 0.775 [95% confidence interval (CI), 0.731–0.819], 0.617 (95%CI, 0.575–0.659), and 0.632 (95%CI, 0.588–0.676), respectively. The calibrated nomogram predicted survival rates which closely corresponded to the actual survival rates. Furthermore, the values of the area under receiver operating characteristic (ROC) curves (AUC) of the nomograms were higher than those of the TNM 7th or 8th stage system in predicting 1-, 2-, and 3-year survival of patients in training and external validation cohorts. The well-calibrated nomogram could be used to predict prognosis for patients with pancreatic adenocarcinoma of the body and tail after surgery.

Highlights

Pancreatic ductal adenocarcinoma (PDAC), which represents one of the most common gastrointestinal tumors, is the fourth cause of cancer deaths in developed countries [1]
The differences in characteristics and prognoses between PDAC of the head and those of the body and tail urged us to pursue a specific staging system for pancreatic body and tail cancer, even though previous studies have compared the predictive power of nomograms in terms of PDAC, [21, 22] which were primarily focused on pancreatic head cancer
The assessment and prediction of prognosis by the established nomogram differed from those made by current TNM staging systems

Summary

Introduction

Pancreatic ductal adenocarcinoma (PDAC), which represents one of the most common gastrointestinal tumors, is the fourth cause of cancer deaths in developed countries [1]. Several independent prognostic factors of PDAC have been identified, such as lymph node (LN) metastasis, tumor size, and resection margin [6, 7]. In these studies, the prognostic influence of risk factors on PDAC of the body and tail is only estimated because the reported predictors of prognosis mainly focus on PDAC occurring at the pancreatic head. It is necessary to develop a technically feasible and an accessible clinical staging system to stratify the prognosis of patients with PDAC of the body and tail when surgery is urgently required

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Conclusion