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Prognostic Nomogram for Resected Pancreatic Adenocarcinoma: A TRIPOD-Compliant Retrospective Long-Term Survival Analysis

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Abstract

Background

Prognostic prediction had been widely used in various cancer entities, from early screening to end-stage patient caring. Currently, there is hardly any well-validated nomogram which exists for long-term survival prediction in pancreatic adenocarcinoma (PC) patients in a post-surgery setting. Our objectives are to identify possible prognostic factors in PC patients following radical resection and to develop a prognostic nomogram based on independent survival predictors.

Methods

From 2009 to 2014, a total of 432 PC patients who underwent curative intended surgeries with complete follow-up data were included in this current retrospective long-term survival analysis. Clinicopathological data were extracted from medical records, and all missing values (percentage 0.9–8.3%) were imputed five times with the “PMM” method. Cox proportional hazards models were utilized. A nomogram was formulated based on results from the multivariate regression model so as to predict OS at 1-, 2- and 3-year as well as median OS. Validations, including discrimination and calibration, were carried out with 1000 bootstrap resamples. External validation was conducted in order to verify the accuracy of our nomogram at 1 and 2 years by utilizing the clinicopathological data of 122 PC patients who underwent curative intended surgeries in 2015 in our centre.

Results

Age, abdominal pain, back pain, tumour location, preoperative neutrophil–lymphocyte ratio, preoperative CA19-9, tumour differentiation, microscopic nerve invasion, microscopic vascular invasion, T stage, lymph node ratio, M stage and adjuvant chemotherapy were all assembled into nomogram. The concordance index (C-index) of internal and external validation was 0.702 and 0.688, respectively. The C-index of the TNM staging system was 0.572 (P < 0.001 vs. nomogram).

Conclusion

Our prognostic nomogram based on clinicopathological parameters shows good performance in long-term survival prediction in PC patients following radical surgery and could play a role in further clinical utilization.

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Funding

Funding was provided by the National Natural Science Foundation of China (Grant No. 81672449), Clinical Frontier Technology of Jiangsu Science and Technology Department (Grant No. BE2016788) and the National Science Foundation for Young Scientists of China (Grant No. 81703301).

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Author notes

  1. Dong Xu and Kai Zhang have contributed equally to this work.

Authors and Affiliations

  1. Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China

    Dong Xu, Kai Zhang, J. P. Neoptolemos, Junli Wu, Wentao Gao, Pengfei Wu, Baobao Cai, Jie Yin, Guodong Shi, Zipeng Lu, Kuirong Jiang & Yi Miao

  2. Pathology Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China

    Mingna Li

  3. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    J. P. Neoptolemos

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  1. Dong Xu
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  2. Kai Zhang
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Correspondence to Zipeng Lu, Kuirong Jiang or Yi Miao.

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Xu, D., Zhang, K., Li, M. et al. Prognostic Nomogram for Resected Pancreatic Adenocarcinoma: A TRIPOD-Compliant Retrospective Long-Term Survival Analysis. World J Surg 44, 1260–1269 (2020). https://doi.org/10.1007/s00268-019-05325-z

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  • DOI: https://doi.org/10.1007/s00268-019-05325-z

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