BACKGROUND: Site of tumour origin, lymph node metastases and lymph node ratio (LNR) are identified as important factors determining prognosis in patients undergoing pancreaticoduodenectomy (PD). This study hypothesised that a prognostic index to predict survival could be developed through statistical modelling based on these pathological variables. METHODS: Patients who underwent PD between 2004 and 2013 were included. Univariable and multivariable (Cox regression) analyses were performed to identify predictors of survival, and a prognostic index was derived. The prognostic index was then validated using an external patient cohort. RESULTS: A total of 567 patients who underwent PD were used as a derivation cohort. Tumour site (p < 0.001), tumour size (p = 0.002), T-stage (p < 0.001), vascular involvement (p = 0.002), number of positive nodes (p < 0.001) and LNR (p < 0.001) were significantly associated with survival in univariable analysis. LNR (p < 0.001), tumour site (p < 0.001), T-stage (p = 0.007) remained significant predictors of survival in multivariable analysis, and were combined to derive a prognostic index. The accuracy of the prognostic index was assessed both on the original cohort, and a validation set of 194 patients from another institutional prospective database. The AUROC scores for predicting the overall survival at 3 years were 0.77 in the derivation cohort and 0.74 in the validation cohort. CONCLUSION: The Pancreaticoduodenectomy Prognostic Index is a validated clinico-pathological model based on tumour site, T-stage and LNR to predict long-term survival following PD.
BACKGROUND: Site of tumour origin, lymph node metastases and lymph node ratio (LNR) are identified as important factors determining prognosis in patients undergoing pancreaticoduodenectomy (PD). This study hypothesised that a prognostic index to predict survival could be developed through statistical modelling based on these pathological variables. METHODS:Patients who underwent PD between 2004 and 2013 were included. Univariable and multivariable (Cox regression) analyses were performed to identify predictors of survival, and a prognostic index was derived. The prognostic index was then validated using an external patient cohort. RESULTS: A total of 567 patients who underwent PD were used as a derivation cohort. Tumour site (p < 0.001), tumour size (p = 0.002), T-stage (p < 0.001), vascular involvement (p = 0.002), number of positive nodes (p < 0.001) and LNR (p < 0.001) were significantly associated with survival in univariable analysis. LNR (p < 0.001), tumour site (p < 0.001), T-stage (p = 0.007) remained significant predictors of survival in multivariable analysis, and were combined to derive a prognostic index. The accuracy of the prognostic index was assessed both on the original cohort, and a validation set of 194 patients from another institutional prospective database. The AUROC scores for predicting the overall survival at 3 years were 0.77 in the derivation cohort and 0.74 in the validation cohort. CONCLUSION: The Pancreaticoduodenectomy Prognostic Index is a validated clinico-pathological model based on tumour site, T-stage and LNR to predict long-term survival following PD.
Authors: Jordan M Winter; John L Cameron; Kurtis A Campbell; Meghan A Arnold; David C Chang; Joann Coleman; Mary B Hodgin; Patricia K Sauter; Ralph H Hruban; Taylor S Riall; Richard D Schulick; Michael A Choti; Keith D Lillemoe; Charles J Yeo Journal: J Gastrointest Surg Date: 2006-11 Impact factor: 3.452
Authors: J P Neoptolemos; J A Dunn; D D Stocken; J Almond; K Link; H Beger; C Bassi; M Falconi; P Pederzoli; C Dervenis; L Fernandez-Cruz; F Lacaine; A Pap; D Spooner; D J Kerr; H Friess; M W Büchler Journal: Lancet Date: 2001-11-10 Impact factor: 79.321
Authors: Jennifer F Tseng; Chandrajit P Raut; Jeffrey E Lee; Peter W T Pisters; Jean-Nicolas Vauthey; Eddie K Abdalla; Henry F Gomez; Charlotte C Sun; Christopher H Crane; Robert A Wolff; Douglas B Evans Journal: J Gastrointest Surg Date: 2004-12 Impact factor: 3.452
Authors: Axel Richter; Marco Niedergethmann; Jörg W Sturm; Dietmar Lorenz; Stefan Post; Michael Trede Journal: World J Surg Date: 2003-02-27 Impact factor: 3.352
Authors: Ioannis Hatzaras; Nathaniel George; Peter Muscarella; W Scott Melvin; E Christopher Ellison; Mark Bloomston Journal: Ann Surg Oncol Date: 2010-01-28 Impact factor: 5.344