Skip to main content

Advertisement

SpringerLink
Log in

Survival prediction for patients with malignant biliary obstruction caused by pancreatic cancer undergoing biliary drainage: the COMBO-PaS model

  • Original Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Patients with pancreatic cancer-caused biliary obstruction (PC-BO) have poor prognosis, but we lack of tools to predict survival for clinical decision-making. This study aims to establish a model for survival prediction among patients with PC-BO.

Methods

A total of 172 patients with PC-BO treated with percutaneous biliary drainage were randomly divided into a training group (n = 120) and a validation group (n = 52). The independent risk factors for overall survival were selected to develop a Cox model. The predictive performance of M stage, hepatic metastases, cancer antigen 199, and the Cox model was determined. Naples prognostic score (NPS), the prognostic nutritional index (PNI), and the controlling nutritional status (CONUT) for 1-month mortality risk were compared with the Cox model.

Results

The Cox model was developed based on total cholesterol, direct bilirubin, hepatic metastases, cancer antigen 199, stenosis type, and preprocedural infection (all P < 0.05), which named “COMBO-PaS.” The COMBO-PaS model had the highest area under the curves (AUC) (0.801–0.933) comparing with other predictors (0.506–0.740) for 1-, 3-, and 6-month survival prediction. For 1-month mortality risk prediction, the COMBO-PaS model had the highest AUC of 0.829 comparing with NPS, PNI, and CONUT.

Conclusion

The COMBO-PaS model was useful for survival prediction among patients with PC-BO.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

AJCC:

American Joint Commission on Cancer

AUC:

Area under the curve

CA:

Cancer antigen

CEA:

Carcinoembryonic antigen

COMBO:

Clinical Outcomes of Malignant Biliary Obstruction

CONUT:

Controlling nutritional status

ECOG:

Eastern Cooperative Oncology Group

IDI:

Integrated discrimination improvement

MBO:

Malignant biliary obstruction

NPS:

Naples prognostic score

NRI:

Net reclassification improvement

OS:

Overall survival

PBD:

Percutaneous biliary drainage

PC-BO:

Pancreatic cancer-caused biliary obstruction

PNI:

Prognostic nutritional index

References

  1. Kapoor BS, Mauri G, Lorenz JM (2018) Management of biliary strictures: state-of-the-art review. Radiology 289(3):590–603. https://doi.org/10.1148/radiol.2018172424

    Article  PubMed  Google Scholar 

  2. Riaz A, Pinkard JP, Salem R, Lewandowski RJ (2019) Percutaneous management of malignant biliary disease. J Surg Oncol 120(1):45–56. https://doi.org/10.1002/jso.25471

    Article  PubMed  Google Scholar 

  3. Boulay BR, Birg A (2016) Malignant biliary obstruction: from palliation to treatment. World J Gastro Oncol 8(6):498. https://doi.org/10.4251/wjgo.v8.i6.498

    Article  Google Scholar 

  4. Dumonceau JM, Tringali A, Papanikolaou IS, Blero D, Mangiavillano B, Schmidt A, Vanbiervliet G, Costamagna G, Deviere J, Garcia-Cano J, Gyokeres T, Hassan C, Prat F, Siersema PD, van Hooft JE (2018) Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 50(9):910–930. https://doi.org/10.1055/a-0659-9864

    Article  PubMed  Google Scholar 

  5. Valle JW, Borbath I, Khan SA, Huguet F, Gruenberger T, Arnold D (2016) Biliary cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 27(suppl 5):v28–v37. https://doi.org/10.1093/annonc/mdw324

    Article  CAS  PubMed  Google Scholar 

  6. NCCN clinical practice guidelines in oncology: Pancreatic adenocarcinoma, version 2. 2021. Available via http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed 17 Sept 2021

  7. Neoptolemos JP, Kleeff J, Michl P, Costello E, Greenhalf W, Palmer DH (2018) Therapeutic developments in pancreatic cancer: current and future perspectives. Nat Rev Gastroenterol Hepatol 15(6):333–348. https://doi.org/10.1038/s41575-018-0005-x

    Article  PubMed  Google Scholar 

  8. Mizrahi JD, Surana R, Valle JW, Shroff RT (2020) Pancreatic cancer. Lancet 395(10242):2008–2020. https://doi.org/10.1016/S0140-6736(20)30974-0

    Article  CAS  PubMed  Google Scholar 

  9. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR, Sullivan DC, Jessup JM, Brierley JD, Gaspar LE, Schilsky RL, Balch CM, Winchester DP, Asare EA, Madera M, Gress DM, Meyer LR (2016) AJCC cancer staging manual. Springer, New York

    Google Scholar 

  10. Kato Y, Yamada S, Suenaga M, Takami H, Niwa Y, Hayashi M, Iwata N, Kanda M, Tanaka C, Nakayama G, Koike M, Fujiwara M, Kodera Y (2018) Impact of the controlling nutritional status score on the prognosis after curative resection of pancreatic ductal adenocarcinoma. Pancreas 47(7):823–829. https://doi.org/10.1097/MPA.0000000000001105

    Article  PubMed  Google Scholar 

  11. Li S, Tian G, Chen Z, Zhuang Y, Li G (2019) Prognostic role of the prognostic nutritional index in pancreatic cancer: a meta-analysis. Nutr Cancer 71(2):207–213. https://doi.org/10.1080/01635581.2018.1559930

    Article  PubMed  Google Scholar 

  12. Liu J, Jiang S, Yang X, Li X, Wang N (2018) The significant value of preoperative prognostic nutritional index for survival in pancreatic cancers. Pancreas 47(7):793–799. https://doi.org/10.1097/MPA.0000000000001089

    Article  PubMed  Google Scholar 

  13. Geng Y, Qi Q, Sun M, Chen H, Wang P, Chen Z (2015) Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer. Eur J Surg Oncol (EJSO) 41(11):1508–1514. https://doi.org/10.1016/j.ejso.2015.07.022

    Article  CAS  PubMed  Google Scholar 

  14. Nakagawa N, Yamada S, Sonohara F, Takami H, Hayashi M, Kanda M, Kobayashi D, Tanaka C, Nakayama G, Koike M, Fujiwara M, Kodera Y (2020) Clinical implications of naples prognostic score in patients with resected pancreatic cancer. Ann Surg Oncol 27(3):887–895. https://doi.org/10.1245/s10434-019-08047-7

    Article  PubMed  Google Scholar 

  15. Ter Veer E, van Rijssen LB, Besselink MG, Mali R, Berlin JD, Boeck S, Bonnetain F, Chau I, Conroy T, Van Cutsem E, Deplanque G, Friess H, Glimelius B, Goldstein D, Herrmann R, Labianca R, Van Laethem JL, Macarulla T, van der Meer J, Neoptolemos JP, Okusaka T, O’Reilly EM, Pelzer U, Philip PA, van der Poel MJ, Reni M, Scheithauer W, Siveke JT, Verslype C, Busch OR, Wilmink JW, van Oijen M, van Laarhoven H (2018) Consensus statement on mandatory measurements in pancreatic cancer trials (COMM-PACT) for systemic treatment of unresectable disease. Lancet Oncol 19(3):e151–e160. https://doi.org/10.1016/S1470-2045(18)30098-6

    Article  PubMed  PubMed Central  Google Scholar 

  16. Vittinghoff E, Mcculloch CE (2007) Relaxing the rule of ten events per variable in logistic and cox regression. Am J Epidemiol 165(6):710–718. https://doi.org/10.1093/aje/kwk052

    Article  PubMed  Google Scholar 

  17. Almadi MA, Barkun A, Martel M (2017) Plastic vs. Self-Expandable metal stents for palliation in malignant biliary obstruction: a series of meta-analyses. Am J Gastroenterol 112(2):260–273. https://doi.org/10.1038/ajg.2016.512

    Article  PubMed  Google Scholar 

  18. Duffy MJ, Sturgeon C, Lamerz R, Haglund C, Holubec VL, Klapdor R, Nicolini A, Topolcan O, Heinemann V (2010) Tumor markers in pancreatic cancer: A European Group on Tumor Markers (EGTM) status report. Ann Oncol 21(3):441–447. https://doi.org/10.1093/annonc/mdp332

    Article  CAS  PubMed  Google Scholar 

  19. Pelzer U, Hilbig A, Sinn M, Stieler J, Bahra M, Dörken B, Riess H (2013) Value of carbohydrate antigen 19–9 in predicting response and therapy control in patients with metastatic pancreatic cancer undergoing first-line therapy. Front Oncol 3:155. https://doi.org/10.3389/fonc.2013.00155

    Article  PubMed  PubMed Central  Google Scholar 

  20. Liu L, Xu H, Wang W, Wu C, Chen Y, Yang J, Cen P, Xu J, Liu C, Long J, Guha S, Fu D, Ni Q, Jatoi A, Chari S, Mccleary-Wheeler AL, Fernandez-Zapico ME, Li M, Yu X (2015) A preoperative serum signature of CEA+/CA125+/CA19-9 ≥ 1000 U/mL indicates poor outcome to pancreatectomy for pancreatic cancer. Int J Cancer 136(9):2216–2227. https://doi.org/10.1002/ijc.29242

    Article  CAS  PubMed  Google Scholar 

  21. Wang Z, Ren Z, Ma N, Zhao J, Zhang Z, Ma X, Long J, Xu J, Jiang G (2015) Intensity modulated radiotherapy for locally advanced and metastatic pancreatic cancer: a mono-institutional retrospective analysis. Radiat Oncol 10(1):14. https://doi.org/10.1186/s13014-014-0312-5

    Article  PubMed  PubMed Central  Google Scholar 

  22. Xue P, Zhu L, Wan Z, Huang W, Li N, Chen D, Hu J, Yang H, Wang L (2015) A prognostic index model to predict the clinical outcomes for advanced pancreatic cancer patients following palliative chemotherapy. J Cancer Res Clin 141(9):1653–1660. https://doi.org/10.1007/s00432-015-1953-y

    Article  CAS  Google Scholar 

  23. Vienot A, Beinse G, Louvet C, de Mestier L, Meurisse A, Fein F, Heyd B, Cleau D, de Engremont C, Dupont-Gossart A, Lakkis Z, Tournigand C, Bouché O, Rousseau B, Neuzillet C, Bonnetain F, Borg C, Vernerey D (2017) Overall survival prediction and usefulness of second-line chemotherapy in advanced pancreatic adenocarcinoma. J Nat Cancer Inst. https://doi.org/10.1093/jnci/djx037

    Article  PubMed  Google Scholar 

  24. Sripongpun P, Attasaranya S, Chamroonkul N, Sookpaisal T, Khow-Ean U, Siripun A, Kongkamol C, Piratvisuth T, Ovartlarnporn B (2018) Simple clinical score to predict 24-Week survival times in patients with inoperable malignant distal biliary obstruction as a tool for selecting palliative metallic or plastic stents. J Gastrointest Cancer 49(2):138–143. https://doi.org/10.1007/s12029-017-9918-9

    Article  PubMed  Google Scholar 

  25. Darnell EP, Wang TJ, Lumish MA, Hernandez-Barco YG, Weniger M, Casey BW, Qadan M, Lillemoe KD, Ferrone CR, Fernandez-Del Castillo C, Krishnan K (2021) Preoperative cholangitis is an independent risk factor for mortality in patients after pancreatoduodenectomy for pancreatic cancer. Am J Surg 221(1):134–140. https://doi.org/10.1016/j.amjsurg.2020.07.025

    Article  PubMed  Google Scholar 

  26. Wiggers JK, Groot Koerkamp B, Cieslak KP, Doussot A, van Klaveren D, Allen PJ, Besselink MG, Busch OR, D’Angelica MI, Dematteo RP, Gouma DJ, Kingham TP, van Gulik TM, Jarnagin WR (2016) Postoperative mortality after liver resection for perihilar cholangiocarcinoma: development of a risk score and importance of biliary drainage of the future liver remnant. J Am Coll Surg 223(2):321–331. https://doi.org/10.1016/j.jamcollsurg.2016.03.035

    Article  PubMed  PubMed Central  Google Scholar 

  27. Xia MX, Wang SP, Wu J, Gao DJ, Ye X, Wang TT, Zhao Y, Hu B (2020) The risk of acute cholangitis after endoscopic stenting for malignant hilar strictures: a large comprehensive study. J Gastroen Hepatol 35(7):1150–1157. https://doi.org/10.1111/jgh.14954

    Article  Google Scholar 

  28. Brountzos EN, Ptochis N, Panagiotou I, Malagari K, Tzavara C, Kelekis D (2007) A survival analysis of patients with malignant biliary strictures treated by percutaneous metallic stenting. Cardiovasc Inter Rad 30(1):66–73. https://doi.org/10.1007/s00270-005-0379-3

    Article  Google Scholar 

  29. Bianconi D, Heller G, Spies D, Herac M, Gleiss A, Liebmann-Reindl S, Unseld M, Kieler M, Scheithauer W, Streubel B, Zielinski CC, Prager GW (2017) Biochemical and genetic predictors of overall survival in patients with metastatic pancreatic cancer treated with capecitabine and nab-paclitaxel. Sci Rep-Uk 7(1):4851. https://doi.org/10.1038/s41598-017-04743-0

    Article  CAS  Google Scholar 

  30. Haas M, Heinemann V, Kullmann F, Laubender RP, Klose C, Bruns CJ, Holdenrieder S, Modest DP, Schulz C, Boeck S (2013) Prognostic value of CA 19–9, CEA, CRP, LDH and bilirubin levels in locally advanced and metastatic pancreatic cancer: results from a multicenter, pooled analysis of patients receiving palliative chemotherapy. J Cancer Res Clin 139(4):681–689. https://doi.org/10.1007/s00432-012-1371-3

    Article  CAS  Google Scholar 

  31. Chakravarty KD (2010) Prognosis and feasibility of en-bloc vascular resection in stage II pancreatic adenocarcinoma. World J Gastroentero 16(8):997. https://doi.org/10.3748/wjg.v16.i8.997

    Article  CAS  Google Scholar 

  32. Eum YO, Kim YT, Lee SH, Park SW, Hwang JH, Yoon WJ, Ryu JK, Yoon YB, Han JK, Yoon CJ, Cho JH, Choi Y (2013) Stent patency using competing risk model in unresectable pancreatic cancers inserted with biliary self-expandable metallic stent. Digest Endosc 25(1):67–75. https://doi.org/10.1111/j.1443-1661.2012.01335.x

    Article  Google Scholar 

  33. Zhang G, Li W, Peng W, Li G, He X, Xu L (2014) Clinical outcomes and prediction of survival following percutaneous biliary drainage for malignant obstructive jaundice. Oncol Lett 7(4):1185–1190. https://doi.org/10.3892/ol.2014.1860

    Article  PubMed  PubMed Central  Google Scholar 

  34. Gao C (2016) Significance and prognostic value of increased serum direct bilirubin level for lymph node metastasis in Chinese rectal cancer patients. World J Gastroentero 22(8):2576. https://doi.org/10.3748/wjg.v22.i8.2576

    Article  CAS  Google Scholar 

  35. Jia Z, Zhu Z, Wang Y, Ding J, Lin Z, Zhang Y, Li Z (2021) The prognostic value of serum bilirubin in colorectal cancer patients with surgical resection. Int J Biol Markers. https://doi.org/10.1177/17246008211036128

    Article  PubMed  Google Scholar 

  36. Lee HA, Jung JY, Lee Y, Jung YK, Kim JH, An H, Yim HJ, Jeen YT, Yeon JE, Byun KS, Um SH, Seo YS (2021) Direct bilirubin is more valuable than total bilirubin for predicting prognosis in patients with liver cirrhosis. Gut Liver 15(4):599–605. https://doi.org/10.5009/gnl20171

    Article  CAS  PubMed  Google Scholar 

  37. Lopez-Velazquez JA, Chavez-Tapia NC, Ponciano-Rodriguez G, Sanchez-Valle V, Caldwell SH, Uribe M, Mendez-Sanchez N (2013) Bilirubin alone as a biomarker for short-term mortality in acute-on-chronic liver failure: an important prognostic indicator. Ann Hepatol 13(1):98–104.

    Article  PubMed  Google Scholar 

  38. Strijker M, Chen JW, Mungroop TH, Jamieson NB, van Eijck CH, Steyerberg EW, Wilmink JW, Groot KB, van Laarhoven HW, Besselink MG (2019) Systematic review of clinical prediction models for survival after surgery for resectable pancreatic cancer. Br J Surg 106(4):342–354. https://doi.org/10.1002/bjs.11111

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Dr. Qin-Quan Zu, Dr. Chun-Gao Zhou, and Dr. Jie Wang from Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China, for their work in the treatment and management of patients. The authors thank Dr. Lin-Bo Zhao, Dr. Zhen-Yu Jia, Dr. Yue-Zhou Cao, Dr. Wei Tian, Dr. Bin Wang, Dr. Xing-Long Liu, Dr. Guang-Dong Lu, Dr. Kai Qiu, and Dr. Run-Hao Jiang from Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China, for their advices for this manuscript.

Funding

This study was supported by the National Natural Science Foundation of China (81701802) and the Jiangsu Provincial Innovative and Entrepreneurial Doctor Program (303073543ER21). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Author notes

  1. Hai-Feng Zhou and Jia-Lei Wang have contributed equally to this article.

Authors and Affiliations

  1. Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China

    Hai-Feng Zhou, Jia-Lei Wang, Wei Yang, Chun Zhou, Yan Shen, Ling-Ling Wu, Zhong-Ling Pei, Wei-Zhong Zhou, Sheng Liu & Hai-Bin Shi

Authors
  1. Hai-Feng Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jia-Lei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chun Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yan Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ling-Ling Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhong-Ling Pei
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wei-Zhong Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sheng Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hai-Bin Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Wei-Zhong Zhou, Sheng Liu or Hai-Bin Shi.

Ethics declarations

Disclosures

All authors, Hai-Feng Zhou, Jia-Lei Wang, Wei Yang, Chun Zhou, Yan Shen, Ling-Ling Wu, Zhong-Ling Pei, Wei-Zhong Zhou, Sheng Liu, and Hai-Bin Shi, declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 8804 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhou, HF., Wang, JL., Yang, W. et al. Survival prediction for patients with malignant biliary obstruction caused by pancreatic cancer undergoing biliary drainage: the COMBO-PaS model. Surg Endosc 37, 1943–1955 (2023). https://doi.org/10.1007/s00464-022-09698-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09698-6

Keywords

Search

Navigation