He Chaobin, Sun Shuxin, Zhang Yu, Lin Xiaojun, Li Shengping
State Key Laboratory of Oncology in South China, Department of Pancreatobiliary Surgery, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Front Oncol. 2020 Sep 3;10:1564. doi: 10.3389/fonc.2020.01564. eCollection 2020.
The post-progression survival (PPS) of patients with pancreatic ductal adenocarcinoma (PDAC) after radical resection is varied and influenced by the characteristics of tumor progression. We aimed to establish and validate a nomogram to predict PPS for PDAC patients after surgery. A total of 302 PDAC patients who had undergone curative resection from 2008 to 2018 were enrolled in this study and randomly divided into training and validation cohorts at a ratio of 3:1. The nomogram was established based on independent prognostic factors selected by LASSO and Cox regression and measured by the area under the receiver operating characteristic curve (AUC) and the concordance index (C-index). Significant prognostic factors included carbohydrate antigen 19-9 (CA19-9), lymph node (LN)9 metastasis, LN14 metastasis, LN16 metastasis, tumor differentiation, imaging-detected tumor size, local progression, liver-only metastasis, lung-only metastasis, and multiple metastases. The nomogram built on these factors showed powerful efficacy in PPS prediction, with C-index values of 0.751 (95% CI 0.692-0.0.810) and 0.710 (95% CI 0.645-0.755) for the training and validation cohorts, respectively. The AUC values for the 1-year and 2-year PSS rates were 0.745, 0.747, and 0.783, 0.748, respectively; these values were higher than those of the 8th tumor-node-metastasis (TNM) stage system. The exploration of risk factors and the establishment of a nomogram can provide new versions of personalized recurrence management for PDAC patients after surgery.
胰腺导管腺癌（PDAC）患者根治性切除术后的进展后生存期（PPS）各不相同，并受肿瘤进展特征的影响。我们旨在建立并验证一种列线图，以预测PDAC患者术后的PPS。本研究纳入了2008年至2018年期间接受根治性切除的302例PDAC患者，并按3:1的比例随机分为训练队列和验证队列。列线图基于通过LASSO和Cox回归选择的独立预后因素建立，并通过受试者操作特征曲线（AUC）下面积和一致性指数（C指数）进行评估。显著的预后因素包括糖类抗原19-9（CA19-9）、淋巴结（LN）9转移、LN14转移、LN16转移、肿瘤分化、影像学检测到的肿瘤大小、局部进展、仅肝转移、仅肺转移和多发转移。基于这些因素构建的列线图在PPS预测中显示出强大的效能，训练队列和验证队列的C指数值分别为0.751（95%CI 0.692-0.810）和0.710（95%CI 0.645-0.755）。1年和2年PSS率的AUC值分别为0.745、0.747和0.783、0.748；这些值高于第八版肿瘤-淋巴结-转移（TNM）分期系统的值。危险因素的探索和列线图的建立可为PDAC患者术后提供新的个性化复发管理方案。
