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
Autor: | Liesbet Van Eycken, Robert Grützmann, Harlinde De Schutter, Yesilda Balavarca, Marc G. Besselink, Valery E.P.P. Lemmens, Tom Børge Johannesen, Vesna Zadnik, Lina Jansen, Margit Mägi, Petra Schrotz-King, Lydia G. M. van der Geest, Lei Huang, Hermann Brenner, Maja Primic-Žakelj |
---|---|
Přispěvatelé: | Graduate School, AGEM - Digestive immunity, AGEM - Endocrinology, metabolism and nutrition, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, Surgery |
Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
Male
Oncology medicine.medical_specialty Benchmark population-based nomogram Survival Population lcsh:Medicine Adenocarcinoma Prognostic factors Cohort Studies 03 medical and health sciences 0302 clinical medicine 610 Medical sciences Medicine Medizinische Fakultät Pancreatic cancer Internal medicine medicine Humans Chemotherapy ddc:610 030212 general & internal medicine Stage (cooking) education Aged education.field_of_study business.industry Proportional hazards model lcsh:R Cancer International real-world cohort study General Medicine Middle Aged Nomogram Prognosis medicine.disease Resection Pancreatic Neoplasms Resection margin T-stage Female business 030217 neurology & neurosurgery Research Article |
Zdroj: | BMC Medicine, Vol 17, Iss 1, Pp 1-16 (2019) BMC medicine, 17(1):66. BioMed Central BMC Medicine |
ISSN: | 1741-7015 |
Popis: | Background Pancreatic 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. Methods Data 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. Results A total of 11,837 resected PaC patients were analyzed, with median survival time of 18–23 months 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. Conclusions In 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. Electronic supplementary material The online version of this article (10.1186/s12916-019-1304-y) contains supplementary material, which is available to authorized users. |
Databáze: | OpenAIRE |
Externí odkaz: | |
Nepřihlášeným uživatelům se plný text nezobrazuje | K zobrazení výsledku je třeba se přihlásit. |