Multi-institutional Development and External Validation of a Nomogram to Predict Recurrence After Curative Resection of Pancreatic Neuroendocrine Tumors.
Multi-institutional Development and External Validation of a Nomogram to Predict Recurrence After Curative Resection of Pancreatic Neuroendocrine Tumors.
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DOI：
10.1097/sla.0000000000003579
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发表时间：
2021-12-01
影响因子：
9
通讯作者：
Bassiy C
中科院分区：
文献类型：
--
作者：
Pulvirenti A;Javed AA;Landoni L;Jamieson NB;Chou JF;Miotto M;He J;Gonen M;Pea A;Tang LH;Nessi C;Cingarlini S;D'Angelica MI;Gill AJ;Kingham TP;Scarpa A;Weiss MJ;Balachandran VP;Samra JS;Cameron JL;Jarnagin WR;Salvia R;Wolfgang CL;Allen PJ;Bassiy C
建立1级(G1级)/2级(G2级)胰腺神经内分泌肿瘤(PanNETs)切除后5年无复发概率的诺模图。在接受PanNETs切除术的患者中，大约17%的患者复发。目前还不能确定哪些患者有风险，也没有就最佳随访达成共识。使用在两个机构治疗的G1/G2 PanNETs患者的多机构数据库来开发一个诺模图，估计在根治性切除后5年的无复发比率。来自另外3个机构的第二批患者被用来验证诺模图。预后因素采用COX回归模型进行单因素分析。使用Bootstrap重抽样方法和外部队列对诺模图进行了内部验证。通过协调性指数(c-index)和校准曲线来评估性能。诺模图是使用632名患者的队列构建的。总体而言，68%的PanNETs为G1期，中位随访时间为51个月，我们观察到74次复发。诺模图中包含的变量包括阳性结节数、肿瘤直径、Ki-67和血管/神经周围侵犯。经内部验证的模型偏差校正c指数为0.85，高于欧洲神经内分泌肿瘤学会/美国癌症联合委员会第8分期方案(c指数0.76，P=0.001)。在328名患者的外部队列中，标准C指数为0.84(95%可信区间为0.79-0.88)。我们的外部验证诺模图预测了PanNETs根治性切除后5年无复发生存的可能性，与当前的分期系统相比，准确度有所提高。评估个体复发风险将指导术后个性化监测计划的发展。
To develop a nomogram estimating the probability of recurrence free at 5 years after resection for localized grade 1 (G1)/ grade 2 (G2) pancreatic neuroendocrine tumors (PanNETs). Among patients undergoing resection of PanNETs, approximately 17% experience recurrence. It is not established which patients are at risk, with no consensus on optimal follow-up. A multi-institutional database of patients with G1/G2 PanNETs treated at 2 institutions was used to develop a nomogram estimating the rate of freedom from recurrence at 5 years after curative resection. A second cohort of patients from 3 additional institutions was used to validate the nomogram. Prognostic factors were assessed by univariate analysis using Cox regression model. The nomogram was internally validated using bootstrap resampling method and on the external cohort. Performance was assessed by concordance index (c-index) and a calibration curve. The nomogram was constructed using a cohort of 632 patients. Overall, 68% of PanNETs were G1, the median follow-up was 51 months, and we observed 74 recurrences. Variables included in the nomogram were the number of positive nodes, tumor diameter, Ki-67, and vascular/perineural invasion. The model bias-corrected c-index from the internal validation was 0.85, which was higher than European Neuroendocrine Tumors Society/American Joint Committee on Cancer 8th staging scheme (c-index 0.76, P=<0.001). On the external cohort of 328 patients, the nomogram c-index was 0.84 (95% confidence interval 0.79–0.88). Our externally validated nomogram predicts the probability of recurrence-free survival at 5 years after PanNETs curative resection, with improved accuracy over current staging systems. Estimating individual recurrence risk will guide the development of personalized surveillance programs after surgery.