Department of Clinical Research, the Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China.
School of Public Health, Guangdong Medical University, Zhanjiang 524023, Guangdong Province, China.
World J Gastroenterol. 2020 Feb 7;26(5):535-549. doi: 10.3748/wjg.v26.i5.535.
There are few effective tools to predict survival in patients with invasive intraductal papillary mucinous neoplasms of the pancreas.
To develop comprehensive nomograms to individually estimate the survival outcome of patients with invasive intraductal papillary mucinous neoplasms of the pancreas.
Data of 1219 patients with invasive intraductal papillary mucinous neoplasms after resection were extracted from the Surveillance, Epidemiology, and End Results database, and randomly divided into the training ( = 853) and the validation ( = 366) cohorts. Based on the Cox regression model, nomograms were constructed to predict overall survival and cancer-specific survival for an individual patient. The performance of the nomograms was measured according to discrimination, calibration, and clinical utility. Moreover, we compared the predictive accuracy of the nomograms with that of the traditional staging system.
In the training cohort, age, marital status, histological type, T stage, N stage, M stage, and chemotherapy were selected to construct nomograms. Compared with the American Joint Committee on Cancer 7 staging system, the nomograms were generally more discriminative. The nomograms passed the calibration steps by showing high consistency between actual probability and nomogram prediction. Categorial net classification improvements and integrated discrimination improvements suggested that the predictive accuracy of the nomograms exceeded that of the American Joint Committee on Cancer staging system. With respect to decision curve analyses, the nomograms exhibited more preferable net benefit gains than the staging system across a wide range of threshold probabilities.
The nomograms show improved predictive accuracy, discrimination capability, and clinical utility, which can be used as reliable tools for risk classification and treatment recommendations.
目前用于预测胰腺侵袭性导管内乳头状黏液性肿瘤患者生存情况的有效工具较少。
开发综合列线图以单独评估胰腺侵袭性导管内乳头状黏液性肿瘤患者的生存结局。
从监测、流行病学和最终结果数据库中提取了 1219 例接受胰腺侵袭性导管内乳头状黏液性肿瘤切除术患者的数据，并将其随机分为训练集（n=853）和验证集（n=366）。基于 Cox 回归模型，构建了预测个体患者总生存和癌症特异性生存的列线图。根据区分度、校准度和临床实用性来评估列线图的性能。此外，还比较了列线图与传统分期系统的预测准确性。
在训练集中，选择年龄、婚姻状况、组织学类型、T 分期、N 分期、M 分期和化疗来构建列线图。与美国癌症联合委员会第 7 分期系统相比，列线图的区分度普遍更高。列线图通过显示实际概率与列线图预测之间的高度一致性通过了校准步骤。分类净分类改善和综合判别改善表明，列线图的预测准确性优于美国癌症联合委员会分期系统。在决策曲线分析中，列线图在广泛的阈值概率范围内比分期系统具有更优的净收益。
列线图显示出了改进的预测准确性、区分能力和临床实用性，可作为风险分类和治疗建议的可靠工具。
