Can physician gestalt predict survival in patients with resectable pancreatic adenocarcinoma?
Clinician gestalt may hold unexplored information that can be capitalized upon to improve existing nomograms. The study objective was to evaluate physician ability to predict 2-year overall survival (OS) in resected pancreatic ductal adenocarcinoma (PDAC) patients based on pre-operative clinical characteristics and routine CT imaging.
Ten surgeons and two radiologists were provided with a clinical vignette (including age, gender, presenting symptoms, and pre-operative CA19-9 when available) and pre-operative CT scan for 20 resected PDAC patients and asked to predict the probability of each patient reaching 2-year OS. Receiver operating characteristic curves were used to assess agreement and to compare performance with an established institutional nomogram.
Ten surgeons and 2 radiologists participated in this study. The area under the curve (AUC) for all physicians was 0.707 (95% CI 0.642–0.772). Attending physicians with > 5 years experience performed better than physicians with < 5 years of clinical experience since completion of post-graduate training (AUC = 0.710, 95% CI [0.536–0.884] compared to AUC = 0.662, 95% CI [0.398–0.927]). Radiologists performed better than surgeons (AUC = 0.875, 95% CI [0.765–0.985] compared to AUC = 0.656, 95% CI [0.580–0.732]). All but one physician outperformed the clinical nomogram (AUC = 0.604).
This pilot study demonstrated significant promise in the quantification of physician gestalt. While PDAC remains a difficult disease to prognosticate, physicians, particularly those with more clinical experience and radiologic expertise, are able to perform with higher accuracy than existing nomograms in predicting 2-year survival.
KeywordsPancreatic adenocarcinoma Survival Prediction Nomogram
Grant support: Linda M. Pak, MD, was supported by the Clinical and Translational Science Center at Weill Cornell Medical Center and MSK award number UL1TR00457. This work was also supported in part by the National Institutes of Health/National Cancer Institute P30 CA008748 Cancer Center Support Grant.
Compliance with ethical standards
This study was supported by the Clinical and Translational Science Center at Weill Cornell Medical Center and MSK Award Number UL1TR00457 and the National Institutes of Health/National Cancer Institute P30 CA008748 Cancer Center Support Grant.
Conflict of interest
All authors declare they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1954 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was waived for this study as it was deemed minimal/no risk to participants by the institutional review board.
- 10.Crane CH, Varadhachary GR, Yordy JS, et al. (2011) Phase II trial of cetuximab, gemcitabine, and oxaliplatin followed by chemoradiation with cetuximab for locally advanced (T4) pancreatic adenocarcinoma: correlation of Smad4(Dpc4) immunostaining with pattern of disease progression. J Clin Oncol 29(22):3037–3043CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Cui Y, Song J, Pollom E, et al. (2016) Quantitative analysis of (18)F-fluorodeoxyglucose positron emission tomography identifies novel prognostic imaging biomarkers in locally advanced pancreatic cancer patients treated with stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 96(1):102–109CrossRefPubMedGoogle Scholar
- 29.Chakraborty J, Langdon-Embry L, Cunanan KM, et al. (in press) Preliminary study of tumor heterogeneity in imaging predicts two year survival in pancreatic cancer patients. PloS ONE.Google Scholar
- 34.Lidsky ME, Sun Z, Nussbaum DP, et al. (2016) Going the extra mile: improved survival for pancreatic cancer patients traveling to high-volume centers. Ann Surg 277:333–338Google Scholar