Ho Kyoung Hwang1,2, Keita Wada3, Ha Yan Kim4, Yuichi Nagakawa5, Yosuke Hijikata5, Yota Kawasaki6, Yoshiharu Nakamura7, Lip Seng Lee8, Dong Sup Yoon1,2, Woo Jung Lee1,2, Chang Moo Kang1,2. 1. Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea. 2. Pancreatobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul 03722, Korea. 3. Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan. 4. Biostatistician, Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Korea. 5. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, Japan. 6. Department of Digestive Surgery, Breast, and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Kagoshima 890-0065, Japan. 7. Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo 890-0065, Japan. 8. Department of General Surgery, Changi General Hospital, Singapore 529889, Singapore.
Abstract
OBJECTIVE: This study aimed to develop a nomogram to predict the 1-year survival of patients with pancreatic cancer who underwent pancreatectomy following neoadjuvant treatment with preoperatively detectable clinical parameters. Extended pancreatectomy is necessary to achieve complete tumor removal in borderline resectable and locally advanced pancreatic cancer. However, it increases postoperative morbidity and mortality rates, and should be balanced with potential benefit of long-term survival. METHODS: The medical records of patients who underwent pancreatectomy following neoadjuvant treatment from January 2005 to December 2016 at Severance Hospital were retrospectively reviewed. Medical records were collected from five international institutions from Japan and Singapore for external validation. RESULTS: A total of 113 patients were enrolled. The nomogram for predicting 1-year disease-specific survival was created based on 5 clinically detectable preoperative parameters as follows: age (year), symptom (no/yes), tumor size at initial diagnostic stage (cm), preoperative serum carbohydrate antigen (CA) 19-9 level after neoadjuvant treatment (<34/≥34 U/mL), and planned surgery [pancreaticoduodenectomy (PD) (pylorus-preserving PD)/distal pancreatectomy (DP)/total pancreatectomy]. Model performance was assessed for discrimination and calibration. The calibration plot showed good agreement between actual and predicted survival probabilities; the the Greenwood-Nam-D'Agostino (GND) goodness-of-fit test showed that the model was well calibrated (χ2=8.24, P=0.5099). A total of 84 patients were used for external validation. When correlating actual disease-specific survival and calculated 1-year disease-specific survival, there were significance differences according to the calculated probability of 1-year survival among the three groups (P=0.044). CONCLUSIONS: The developed nomogram had quite acceptable accuracy and clinical feasibility in the decision-making process for the management of pancreatic cancer.
OBJECTIVE: This study aimed to develop a nomogram to predict the 1-year survival of patients with pancreatic cancer who underwent pancreatectomy following neoadjuvant treatment with preoperatively detectable clinical parameters. Extended pancreatectomy is necessary to achieve complete tumor removal in borderline resectable and locally advanced pancreatic cancer. However, it increases postoperative morbidity and mortality rates, and should be balanced with potential benefit of long-term survival. METHODS: The medical records of patients who underwent pancreatectomy following neoadjuvant treatment from January 2005 to December 2016 at Severance Hospital were retrospectively reviewed. Medical records were collected from five international institutions from Japan and Singapore for external validation. RESULTS: A total of 113 patients were enrolled. The nomogram for predicting 1-year disease-specific survival was created based on 5 clinically detectable preoperative parameters as follows: age (year), symptom (no/yes), tumor size at initial diagnostic stage (cm), preoperative serum carbohydrate antigen (CA) 19-9 level after neoadjuvant treatment (<34/≥34 U/mL), and planned surgery [pancreaticoduodenectomy (PD) (pylorus-preserving PD)/distal pancreatectomy (DP)/total pancreatectomy]. Model performance was assessed for discrimination and calibration. The calibration plot showed good agreement between actual and predicted survival probabilities; the the Greenwood-Nam-D'Agostino (GND) goodness-of-fit test showed that the model was well calibrated (χ2=8.24, P=0.5099). A total of 84 patients were used for external validation. When correlating actual disease-specific survival and calculated 1-year disease-specific survival, there were significance differences according to the calculated probability of 1-year survival among the three groups (P=0.044). CONCLUSIONS: The developed nomogram had quite acceptable accuracy and clinical feasibility in the decision-making process for the management of pancreatic cancer.
Authors: Hop S Tran Cao; Qianzi Zhang; Yvonne H Sada; Eric J Silberfein; Cary Hsu; George Van Buren; Christy Chai; Matthew H G Katz; William E Fisher; Nader N Massarweh Journal: Surgery Date: 2017-06-27 Impact factor: 3.982
Authors: Ali A Mokdad; Rebecca M Minter; Hong Zhu; Mathew M Augustine; Matthew R Porembka; Sam C Wang; Adam C Yopp; John C Mansour; Michael A Choti; Patricio M Polanco Journal: J Clin Oncol Date: 2016-09-30 Impact factor: 44.544
Authors: S Pedrazzoli; V DiCarlo; R Dionigi; F Mosca; P Pederzoli; C Pasquali; G Klöppel; K Dhaene; F Michelassi Journal: Ann Surg Date: 1998-10 Impact factor: 12.969
Authors: E Versteijne; J A Vogel; M G Besselink; O R C Busch; J W Wilmink; J G Daams; C H J van Eijck; B Groot Koerkamp; C R N Rasch; G van Tienhoven Journal: Br J Surg Date: 2018-04-30 Impact factor: 6.939