Jae Seung Kang1, Lydia Mok2, Jin Seok Heo3, In Woong Han3, Sang Hyun Shin3, Yoo-Seok Yoon4, Ho-Seong Han4, Dae Wook Hwang5, Jae Hoon Lee5, Woo Jung Lee6, Sang Jae Park7, Joon Seong Park8, Yonghoon Kim9, Huisong Lee10, Young-Dong Yu11, Jae Do Yang12, Seung Eun Lee13, Il Young Park14, Chi-Young Jeong15, Younghoon Roh16, Seong-Ryong Kim17, Ju Ik Moon18, Sang Kuon Lee19, Hee Joon Kim20, Seungyeoun Lee21, Hongbeom Kim22, Wooil Kwon22, Chang-Sup Lim1, Jin-Young Jang22, Taesung Park2. 1. Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea. 2. Department of Statistics and Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, Korea. 3. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 4. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea. 5. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 6. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. 7. Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea. 8. Pancreatobiliary Cancer Clinic, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 9. Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea. 10. Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea. 11. Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Korea. 12. Department of Surgery, Jeonbuk National University Medical School, Jeonju, Korea. 13. Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea. 14. Department of General Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea. 15. Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea. 16. Department of Surgery, Dong-A University College of Medicine, Busan, Korea. 17. Department of Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea. 18. Department of Surgery, Konyang University Hospital, Daejeon, Korea. 19. Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea. 20. Department of Surgery, Chonnam National University Hospital, Gwangju, Korea. 21. Department of Mathematics and Statistics, Sejong University, Seoul, Korea. 22. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Abstract
Background/Aims: Several prediction models for evaluating the prognosis of nonmetastatic resected pancreatic ductal adenocarcinoma (PDAC) have been developed, and their performances were reported to be superior to that of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. We developed a prediction model to evaluate the prognosis of resected PDAC and externally validated it with data from a nationwide Korean database. Methods: Data from the Surveillance, Epidemiology and End Results (SEER) database were utilized for model development, and data from the Korea Tumor Registry System-Biliary Pancreas (KOTUS-BP) database were used for external validation. Potential candidate variables for model development were age, sex, histologic differentiation, tumor location, adjuvant chemotherapy, and the AJCC 8th staging system T and N stages. For external validation, the concordance index (C-index) and time-dependent area under the receiver operating characteristic curve (AUC) were evaluated. Results: Between 2004 and 2016, data from 9,624 patients were utilized for model development, and data from 3,282 patients were used for external validation. In the multivariate Cox proportional hazard model, age, sex, tumor location, T and N stages, histologic differentiation, and adjuvant chemotherapy were independent prognostic factors for resected PDAC. After an exhaustive search and 10-fold cross validation, the best model was finally developed, which included all prognostic variables. The C-index, 1-year, 2-year, 3-year, and 5-year time-dependent AUCs were 0.628, 0.650, 0.665, 0.675, and 0.686, respectively. Conclusions: The survival prediction model for resected PDAC could provide quantitative survival probabilities with reliable performance. External validation studies with other nationwide databases are needed to evaluate the performance of this model.
Background/Aims: Several prediction models for evaluating the prognosis of nonmetastatic resected pancreatic ductal adenocarcinoma (PDAC) have been developed, and their performances were reported to be superior to that of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. We developed a prediction model to evaluate the prognosis of resected PDAC and externally validated it with data from a nationwide Korean database. Methods: Data from the Surveillance, Epidemiology and End Results (SEER) database were utilized for model development, and data from the Korea Tumor Registry System-Biliary Pancreas (KOTUS-BP) database were used for external validation. Potential candidate variables for model development were age, sex, histologic differentiation, tumor location, adjuvant chemotherapy, and the AJCC 8th staging system T and N stages. For external validation, the concordance index (C-index) and time-dependent area under the receiver operating characteristic curve (AUC) were evaluated. Results: Between 2004 and 2016, data from 9,624 patients were utilized for model development, and data from 3,282 patients were used for external validation. In the multivariate Cox proportional hazard model, age, sex, tumor location, T and N stages, histologic differentiation, and adjuvant chemotherapy were independent prognostic factors for resected PDAC. After an exhaustive search and 10-fold cross validation, the best model was finally developed, which included all prognostic variables. The C-index, 1-year, 2-year, 3-year, and 5-year time-dependent AUCs were 0.628, 0.650, 0.665, 0.675, and 0.686, respectively. Conclusions: The survival prediction model for resected PDAC could provide quantitative survival probabilities with reliable performance. External validation studies with other nationwide databases are needed to evaluate the performance of this model.