Prognosis Based Definition of Resectability in Pancreatic Cancer
- 6 March 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 275 (1), 175-181
- https://doi.org/10.1097/sla.0000000000003859
Abstract
Objective: To identify objective preoperative prognostic factors that are able to predict long-term survival of patients affected by PDAC. Summary of Background Data: In the modern era of improved systemic chemotherapy for PDAC, tumor biology, and response to chemotherapy are essential in defining prognosis and an improved approach is needed for classifying resectability beyond purely anatomic features. Methods: We queried the National Cancer Database regarding patients diagnosed with PDAC from 2010 to 2016. Cox proportional hazard models were used to select preoperative baseline factors significantly associated with survival; final models for overall survival (OS) were internally validated and formed the basis of the nomogram. Results: A total of 7849 patients with PDAC were included with a median follow-up of 19 months. On multivariable analysis, factors significantly associated with OS included carbohydrate antigen 19-9, neoadjuvant treatment, tumor size, age, facility type, Charlson/Deyo score, primary site, and sex; T4 stage was not independently associated with OS. The cumulative score was used to classify patients into 3 groups: good, intermediate, and poor prognosis, respectively. The strength of our model was validated by a highly significant randomization test, Log-rank test, and simple hazard ratio; the concordance index was 0.59. Conclusion: This new PDAC nomogram, based solely on preoperative variables, could be a useful tool to patients and counseling physicians in selecting therapy. This model suggests a new concept of resectability that is meant to reflect the biology of the tumor, thus partially overcoming existing definitions, that are mainly based on tumor anatomic features.Keywords
This publication has 35 references indexed in Scilit:
- Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicatorsCancer, 2012
- Arterial Resection During Pancreatectomy for Pancreatic CancerAnnals of Surgery, 2011
- Pancreatic Cancer Surgery in the New MillenniumAnnals of Surgery, 2011
- Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancerSurgery, 2009
- Individualized Prediction of Colon Cancer Recurrence Using a NomogramJournal of Clinical Oncology, 2008
- The National Cancer Data Base: A Powerful Initiative to Improve Cancer Care in the United StatesAnnals of Surgical Oncology, 2008
- Pancreatic Adenocarcinoma: Value of Multidetector CT Angiography in Preoperative EvaluationRadiology, 2007
- Prognostic Nomogram for Patients Undergoing Resection for Adenocarcinoma of the PancreasAnnals of Surgery, 2004
- A Randomized Trial of Chemoradiotherapy and Chemotherapy after Resection of Pancreatic CancerThe New England Journal of Medicine, 2004
- Projecting Individualized Probabilities of Developing Breast Cancer for White Females Who Are Being Examined AnnuallyJNCI Journal of the National Cancer Institute, 1989