Prognostic nomogram for patients with unresectable pancreatic cancer treated with gemcitabine plus nab–paclitaxel or FOLFIRINOX: A post–hoc analysis of a multicenter retrospective study in Japan (NAPOLEON study)

BMC Cancer

Mototsugu Shimokawa¹  Takuya Honda²  Hiroki Taguchi³  Yujiro Ueda⁴  Akitaka Makiyama⁵  Futa Koga⁶  Taro Shibuki⁷  Toshihiko Mizuta⁸  Yasushi Ide⁹  Satoshi Otsu^1,10  Azusa Komori^1,10  Tsuyoshi Shirakawa^1,11  Kenta Nio^1,12  Kenji Mitsugi^1,12  Junichi Nakazawa^1,13  Taiga Otsuka^1,14  Norio Ureshino^1,15  Shiho Arima^1,16  Masaru Fukahori^1,17 

[1] Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka-shi, 811-1395, Fukuoka, Japan;Department of Biostatistics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, 755-8505, Yamaguchi, Japan;Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki-shi, 852-8501, Nagasaki, Japan;Department of Gastroenterology, Saiseikai Sendai Hospital, 2-46 Harada-machi, Satsumasendai-shi, 895-0074, Kagoshima, Japan;Department of Gastroenterology, Izumi General Medical Center, 520 Myojincho, Izumi-shi, 899-0131, Kagoshima, Japan;Department of Hematology and Oncology, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto-shi, 861-8520, Kumamoto, Japan;Department of Hematology/Oncology, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu-shi, 806-8501, Fukuoka, Japan;Cancer Center, Gifu University Hospital, 1-1 Yanagido, Gifu-shi, 501-1194, Gifu, Japan;Department of Hepatobiliary and Pancreatology, Saga Medical Center Koseikan, 400 Kase-machi, Saga-shi, 840-8571, Saga, Japan;Department of Internal Medicine, Imari Arita Kyoritsu Hospital, 860 Ninose-ko, Arita-cho, Nishi-matsuura-gun, 849-4193, Saga, Japan;Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, 277-8577, Chiba, Japan;Department of Internal Medicine, Imari Arita Kyoritsu Hospital, 860 Ninose-ko, Arita-cho, Nishi-matsuura-gun, 849-4193, Saga, Japan;Department of Internal Medicine, Fujikawa Hospital, 1-2-6 Matsubara, Saga-shi, 840-0831, Saga, Japan;Department of Internal Medicine, Karatsu Red Cross Hospital, 2430 Watada, Karatsu-shi, 847-8588, Saga, Japan;Department of Medical Oncology and Hematology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, 879-5593, Yufu-shi, Oita, Japan;Department of Medical Oncology, Fukuoka Wajiro Hospital, 2-2-75 Wajirogaoka, Higashi-ku, Fukuoka-shi, 811-0213, Fukuoka, Japan;Karatsu Higashi-matsuura Medical Association Center, 2566-11 Chiyoda-machi, Karatsu-shi, 847-0041, Saga, Japan;Department of Medical Oncology, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka-shi, 810-8539, Fukuoka, Japan;Department of Medical Oncology, Sasebo Kyosai Hospital, 10-17 Shimanji-cho, Sasebo-shi, 857-8575, Nagasaki, Japan;Department of Medical Oncology, Kagoshima City Hospital, 37-1 Uearata-cho, Kagoshima-shi, 890-8760, Kagoshima, Japan;Department of Medical Oncology, Saga Medical Center Koseikan, 400 Kase-machi, Saga-shi, 840-8571, Saga, Japan;Department of Internal Medicine, Minato Medical Clinic, 3-11-3 Nagahama, Chuo-ku, Fukuoka-shi, 810-0072, Fukuoka, Japan;Department of Medical Oncology, Saga Medical Center Koseikan, 400 Kase-machi, Saga-shi, 840-8571, Saga, Japan;Department of Medical Oncology, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu-shi, 292-8535, Chiba, Japan;Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima-shi, 890-8520, Kagoshima, Japan;Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, 830-0011, Fukuoka, Japan;

关键词: unresectable pancreatic cancer;    nomogram;    prognosis;    overall survival;    chemotherapy;   

DOI  :  10.1186/s12885-021-09139-y

来源: Springer

【 摘 要 】

BackgroundNo reliable nomogram has been developed until date for predicting the survival in patients with unresectable pancreatic cancer undergoing treatment with gemcitabine plus nab–paclitaxel (GnP) or FOLFIRINOX.MethodsThis analysis was conducted using clinical data of Japanese patients with unresectable pancreatic cancer undergoing GnP or FOLFIRINOX treatment obtained from a multicenter study (NAPOLEON study). A Cox proportional hazards model was used to identify the independent prognostic factors. A nomogram to predict 6–, 12–, and 18–month survival probabilities was generated, validated by using the concordance index (C–index), and calibrated by the bootstrapping method. And then, we attempted risk stratification for survival by classifying the patients according to the sum of the scores on the nomogram (total nomogram points).ResultsA total of 318 patients were enrolled. A prognostic nomogram was generated using data on the Eastern Cooperative Oncology Group performance status, liver metastasis, serum LDH, serum CRP, and serum CA19–9. The C–indexes of the nomogram were 0.77, 0.72 and 0.70 for 6–, 12–, and 18–month survival, respectively. The calibration plot showed optimal agreement at all points. Risk stratification based on tertiles of the total nomogram points yielded clear separations of the survival curves. The median survival times in the low–, moderate–, and high–risk groups were 15.8, 12.8 and 7.8 months (P<0.05), respectively.ConclusionsOur nomogram might be a convenient and inexpensive tool to accurately predict survival in Japanese patients with unresectable pancreatic cancer undergoing treatment with GnP or FOLFIRINOX, and will help clinicians in selecting appropriate therapeutic strategies for individualized management.

【 授权许可】

CC BY