Linda M Pak1, Mithat Gonen2, Kenneth Seier2, Vinod P Balachandran1, Michael I D'Angelica1, William R Jarnagin1, T Peter Kingham1, Peter J Allen1, Richard K G Do3, Amber L Simpson4. 1. Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA. 2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA. 3. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 4. Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA. simpsonl@mskcc.org.
Abstract
PURPOSE: Clinician gestalt may hold unexplored information that can be capitalized upon to improve existing nomograms. The study objective was to evaluate physician ability to predict 2-year overall survival (OS) in resected pancreatic ductal adenocarcinoma (PDAC) patients based on pre-operative clinical characteristics and routine CT imaging. METHODS: Ten surgeons and two radiologists were provided with a clinical vignette (including age, gender, presenting symptoms, and pre-operative CA19-9 when available) and pre-operative CT scan for 20 resected PDAC patients and asked to predict the probability of each patient reaching 2-year OS. Receiver operating characteristic curves were used to assess agreement and to compare performance with an established institutional nomogram. RESULTS: Ten surgeons and 2 radiologists participated in this study. The area under the curve (AUC) for all physicians was 0.707 (95% CI 0.642-0.772). Attending physicians with > 5 years experience performed better than physicians with < 5 years of clinical experience since completion of post-graduate training (AUC = 0.710, 95% CI [0.536-0.884] compared to AUC = 0.662, 95% CI [0.398-0.927]). Radiologists performed better than surgeons (AUC = 0.875, 95% CI [0.765-0.985] compared to AUC = 0.656, 95% CI [0.580-0.732]). All but one physician outperformed the clinical nomogram (AUC = 0.604). CONCLUSIONS: This pilot study demonstrated significant promise in the quantification of physician gestalt. While PDAC remains a difficult disease to prognosticate, physicians, particularly those with more clinical experience and radiologic expertise, are able to perform with higher accuracy than existing nomograms in predicting 2-year survival.
PURPOSE: Clinician gestalt may hold unexplored information that can be capitalized upon to improve existing nomograms. The study objective was to evaluate physician ability to predict 2-year overall survival (OS) in resected pancreatic ductal adenocarcinoma (PDAC) patients based on pre-operative clinical characteristics and routine CT imaging. METHODS: Ten surgeons and two radiologists were provided with a clinical vignette (including age, gender, presenting symptoms, and pre-operative CA19-9 when available) and pre-operative CT scan for 20 resected PDACpatients and asked to predict the probability of each patient reaching 2-year OS. Receiver operating characteristic curves were used to assess agreement and to compare performance with an established institutional nomogram. RESULTS: Ten surgeons and 2 radiologists participated in this study. The area under the curve (AUC) for all physicians was 0.707 (95% CI 0.642-0.772). Attending physicians with > 5 years experience performed better than physicians with < 5 years of clinical experience since completion of post-graduate training (AUC = 0.710, 95% CI [0.536-0.884] compared to AUC = 0.662, 95% CI [0.398-0.927]). Radiologists performed better than surgeons (AUC = 0.875, 95% CI [0.765-0.985] compared to AUC = 0.656, 95% CI [0.580-0.732]). All but one physician outperformed the clinical nomogram (AUC = 0.604). CONCLUSIONS: This pilot study demonstrated significant promise in the quantification of physician gestalt. While PDAC remains a difficult disease to prognosticate, physicians, particularly those with more clinical experience and radiologic expertise, are able to perform with higher accuracy than existing nomograms in predicting 2-year survival.
Authors: Alessandro Paniccia; Patrick Hosokawa; William Henderson; Richard D Schulick; Barish H Edil; Martin D McCarter; Csaba Gajdos Journal: JAMA Surg Date: 2015-08 Impact factor: 14.766
Authors: Sam C Wang; Justin R Parekh; Matthew R Porembka; Hari Nathan; Michael I D'Angelica; Ronald P DeMatteo; Yuman Fong; T Peter Kingham; William R Jarnagin; Peter J Allen Journal: J Gastrointest Surg Date: 2016-02-26 Impact factor: 3.452
Authors: Shinichi Yachida; Catherine M White; Yoshiki Naito; Yi Zhong; Jacqueline A Brosnan; Anne M Macgregor-Das; Richard A Morgan; Tyler Saunders; Daniel A Laheru; Joseph M Herman; Ralph H Hruban; Alison P Klein; Siân Jones; Victor Velculescu; Christopher L Wolfgang; Christine A Iacobuzio-Donahue Journal: Clin Cancer Res Date: 2012-09-18 Impact factor: 12.531
Authors: Cristina R Ferrone; Michael W Kattan; James S Tomlinson; Sarah P Thayer; Murray F Brennan; Andrew L Warshaw Journal: J Clin Oncol Date: 2005-10-20 Impact factor: 44.544
Authors: Jacques Ferlay; Isabelle Soerjomataram; Rajesh Dikshit; Sultan Eser; Colin Mathers; Marise Rebelo; Donald Maxwell Parkin; David Forman; Freddie Bray Journal: Int J Cancer Date: 2014-10-09 Impact factor: 7.396
Authors: Daniel M Relles; Richard A Burkhart; Michael J Pucci; Jocelyn Sendecki; Renee Tholey; Ross Drueding; Patricia K Sauter; Eugene P Kennedy; Jordan M Winter; Harish Lavu; Charles J Yeo Journal: J Gastrointest Surg Date: 2013-11-13 Impact factor: 3.452