Lee Hee Seung, An Chansik, Hwang Ho Kyoung, Roh Yun Ho, Kang Huapyong, Jo Jung Hyun, Chung Moon Jae, Park Jeong Youp, Kang Chang Moo, Park Seung Woo, Yoon Dong Sup, Lee Woo Jung, Song Si Young, Bang Seungmin
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
J Gastroenterol Hepatol. 2020 Mar;35(3):499-507. doi: 10.1111/jgh.14837. Epub 2019 Sep 3.
The aim of this study is to identify the predictive factors for futile surgery in patients with radiologically resectable or borderline resectable pancreatic cancer and to develop a prediction model.
This retrospective study included patients who underwent pancreatic surgery for pancreatic cancer between 2006 and 2017. To identify independent risk factors for futile surgery, logistic regression and random forest analyses were performed in the training cohort, based on which a nomogram was established. The predictive accuracy and discriminative ability of the nomogram were validated in the validation cohort.
Of 389 patients who underwent pancreatic surgery, the laparotomy was futile in 40 patients (10.3%). In the training cohort, the univariate and multivariate logistic regression analyses revealed that serum carbohydrate antigen 19-9 level of ≥ 150 U/mL (P = 0.003), the presence of suspicious lymph node (P = 0.013), and more extensive peripancreatic tumor infiltration (P < 0.001) were independent predictive factors for futile surgery. The bootstrap-corrected concordance index of the nomogram was high in the training cohort, 0.826 with a 95% confidence interval of 0.745-0.907. This model also showed a good discriminative performance in the validation cohort, with a concordance index of 0.831.
We established and validated a novel nomogram that predicts the risk of futile surgery due to occult distant metastasis in patients with radiologically resectable or borderline resectable pancreatic cancer.
本研究旨在确定影像学上可切除或临界可切除胰腺癌患者进行无意义手术的预测因素，并建立预测模型。
这项回顾性研究纳入了2006年至2017年间因胰腺癌接受胰腺手术的患者。为了确定无意义手术的独立危险因素，在训练队列中进行了逻辑回归和随机森林分析，并在此基础上建立了列线图。在验证队列中验证了列线图的预测准确性和判别能力。
在389例行胰腺手术的患者中，40例（10.3%）剖腹手术无意义。在训练队列中，单因素和多因素逻辑回归分析显示，血清糖类抗原19-9水平≥150 U/mL（P = 0.003）、存在可疑淋巴结（P = 0.013）以及胰腺周围肿瘤浸润范围更广（P < 0.001）是无意义手术的独立预测因素。列线图在训练队列中的自抽样校正一致性指数较高，为0.826，95%置信区间为0.745 - 0.907。该模型在验证队列中也显示出良好的判别性能，一致性指数为0.831。
我们建立并验证了一种新型列线图，可预测影像学上可切除或临界可切除胰腺癌患者因隐匿性远处转移导致无意义手术的风险。
