Prognostic Nomogram for Resected Pancreatic Adenocarcinoma: A TRIPOD-Compliant Retrospective Long-Term Survival Analysis
Prognostic Nomogram for Resected Pancreatic Adenocarcinoma: A TRIPOD-Compliant Retrospective Long-Term Survival Analysis
复制标题
切除的胰腺腺癌的预后列线图：符合 TRIPOD 的回顾性长期生存分析
DOI：
10.1007/s00268-019-05325-z
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发表时间：
2020
影响因子：
2.6
通讯作者：
Miao Yi
中科院分区：
文献类型：
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作者：
Xu Dong;Zhang Kai;Li Mingna;Neoptolemos J. P.;Wu Junli;Gao Wentao;Wu Pengfei;Cai Baobao;Yin Jie;Shi Guodong;Lu Zipeng;Jiang Kuirong;Miao Yi
预后预测已广泛应用于各种癌症实体，从早期筛查到终末期患者护理。目前，对于胰腺癌（PC）患者术后的长期生存预测，几乎没有任何经过良好验证的nomogram。我们的目标是确定根治性切除后PC患者可能的预后因素，并基于独立的生存预测因素制定预后图。方法从2009年到2014年，共有432例PC患者接受了治愈性手术，并有完整的随访数据，纳入了当前的回顾性长期生存分析。从病历中提取临床病理资料，用“PMM”法对所有缺失值（百分比0.9-8.3%）进行5次代入。采用Cox比例风险模型。根据多变量回归模型的结果制定了一个nomogram，以预测1年、2年和3年的OS以及中位OS。用1000个bootstrap样本进行了验证，包括鉴别和校准。为了验证我们1年和2年nomogram的准确性，我们利用了2015年在我们中心接受治疗性手术的122例PC患者的临床病理数据。结果年龄、腹痛、背痛、肿瘤位置、术前中性粒细胞/淋巴细胞比值、术前CA19‐9、肿瘤分化、镜下神经侵犯、镜下血管侵犯、T分期、淋巴结比例、M分期、辅助化疗均集结成nomogram。内部验证和外部验证的一致性指数（C‐index）分别为0.702和0.688。TNM分期系统的C指数为0.572 （P 0.001 vs. nomogram）。结论基于临床病理参数的预后nomogram预测PC根治性手术后患者的长期生存，具有一定的临床应用价值。
BackgroundPrognostic 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.MethodsFrom 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.ResultsAge, 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).ConclusionOur 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.