Development and validation of a prognostic model to predict the prognosis of patients who underwent chemotherapy and resection of pancreatic adenocarcinoma: a large international population-based cohort study

BMC Medicine

Liesbet Van Eycken¹  Harlinde De Schutter¹  Robert Grützmann²  Lei Huang³  Lina Jansen³  Hermann Brenner³  Petra Schrotz-King⁴  Yesilda Balavarca⁴  Marc G. Besselink⁵  Vesna Zadnik⁶  Maja Primic-Žakelj⁶  Margit Mägi⁷  Lydia van der Geest⁸  Valery Lemmens⁸  Tom B. Johannesen⁹ 

[1] Belgian Cancer Registry (BCR);Department of Surgery, Friedrich-Alexander-University Erlangen-Nürnberg;Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ);Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT);Dutch Pancreatic Cancer Group (DPCG), Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers (UMC), Academic Medical Center (AMC), University of Amsterdam;Epidemiology and Cancer Registry, Institute of Oncology Ljubljana;Estonian Cancer Registry, National Institute for Health Development;Netherlands Cancer Registry (NCR), Netherlands Comprehensive Cancer Organization (IKNL);Registry Department, The Cancer Registry of Norway (CRN);

关键词: Pancreatic cancer;    Resection;    Chemotherapy;    Survival;    Prognostic factors;    Benchmark population-based nomogram;   

DOI  :  10.1186/s12916-019-1304-y

来源: DOAJ

【 摘 要 】

Abstract Background Pancreatic cancer (PaC) remains extremely lethal worldwide even after resection. PaC resection rates are low, making prognostic studies in resected PaC difficult. This large international population-based study aimed at exploring factors associated with survival in patients with resected TNM stage I–II PaC receiving chemotherapy and at developing and internationally validating a survival-predicting model. Methods Data of stage I–II PaC patients resected and receiving chemotherapy in 2003–2014 were obtained from the national cancer registries of Belgium, the Netherlands, Slovenia, and Norway, and the US Surveillance, Epidemiology, and End Results (SEER)-18 Program. Multivariable Cox proportional hazards models were constructed to investigate the associations of patient and tumor characteristics with overall survival, and analysis was performed in each country respectively without pooling. Prognostic factors remaining after backward selection in SEER-18 were used to build a nomogram, which was subjected to bootstrap internal validation and external validation using the European datasets. Results A total of 11,837 resected PaC patients were analyzed, with median survival time of 18–23 months and 3-year survival rates of 21–31%. In the main analysis, patient age, tumor T stage, N stage, and differentiation were associated with survival across most countries, with country-specific association patterns and strengths. However, tumor location was mostly not significantly associated with survival. Resection margin, hospital type, tumor size, positive and harvested lymph node number, lymph node ratio, and comorbidity number were associated with survival in certain countries where the information was available. A median survival time- and 1-, 2-, 3-, and 5-year survival probability-predictive nomogram incorporating the backward-selected variables in the main analysis was established. It fits each European national cohort similarly well. Calibration curves showed very good agreement between nomogram-prediction and actual observation. The concordance index of the nomogram (0.60) was significantly higher than that of the T and N stage-based model (0.56) for predicting survival. Conclusions In these large international population-based cohorts, patients with resected PaC receiving chemotherapy have distinct characteristics independently associated with survival, with country-specific patterns and strengths. A robust benchmark population-based survival-predicting model is established and internationally validated. Like previous models predicting survival in resected PaC, our nomogram performs modestly.

【 授权许可】

Unknown