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

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Details zur Publikation

Autorinnen und Autoren: Huang L, Balavarca Y, Van Der Geest L, Lemmens V, Van Eycken L, De Schutter H, Johannesen TB, Zadnik V, Primic-Zakelj M, Magi M, Grützmann R, Besselink MG, Schrotz-King P, Brenner H, Jansen L
Zeitschrift: Bmc Medicine
Jahr der Veröffentlichung: 2019
Band: 17
ISSN: 1741-7015


Abstract

BackgroundPancreatic 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.MethodsData 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.ResultsA total of 11,837 resected PaC patients were analyzed, with median survival time of 18-23months 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.ConclusionsIn 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.


FAU-Autorinnen und Autoren / FAU-Herausgeberinnen und Herausgeber

Grützmann, Robert Prof. Dr.
Lehrstuhl für Allgemein- und Viszeralchirurgie


Einrichtungen weiterer Autorinnen und Autoren

Belgian Cancer Registry (BCR) / Stichting Kankerregister
Deutsches Krebsforschungszentrum (DKFZ)
Institute for Oncology Ljubljana (OIL)
Netherlands Comprehensive Cancer Organisation / Integraal Kankercentrum Nederland (IKNL)
University of Amsterdam


Zitierweisen

APA:
Huang, L., Balavarca, Y., Van Der Geest, L., Lemmens, V., Van Eycken, L., De Schutter, H.,... Jansen, L. (2019). 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, 17. https://dx.doi.org/10.1186/s12916-019-1304-y

MLA:
Huang, Lei, et al. "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 17 (2019).

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Zuletzt aktualisiert 2019-08-04 um 12:53