开发和验证一种针对老年胰头癌患者胰十二指肠切除术后安全性和疗效的网络计算器模型。
Development and validation of a network calculator model for safety and efficacy after pancreaticoduodenectomy in the elderly patients with pancreatic head cancer.
机构信息
Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
出版信息
Cancer Med. 2023 Oct;12(19):19673-19689. doi: 10.1002/cam4.6613. Epub 2023 Oct 3.
BACKGROUND
Benefiting from increased life expectancy and improved perioperative management, more elderly patients with pancreatic head cancer (PHC) underwent pancreaticoduodenectomy (PD). However, individualized predictive models for the safety and efficacy of PD is still lacking. this study aimed to developed three safety- and efficacy-related risk calculators for elderly (> = 65 years) PHC patients.
METHODS
This study was designed with two research cohorts, namely, the training cohort and the validation cohort, and comprises four general steps: (1) Risk factors were analyzed for the incidence of postoperative complications, cancer-specific survival (CSS), and overall survival (OS) in the training cohort (N = 271) using logistic and Cox-regression analysis. (2) Nomograms were then plotted based on the above results. (3) The accuracy of the developed nomogram models was then verified with the validation cohort (N = 134) data using consistency index (C-index) and calibration curves. (4) We then evaluated the efficacy of these nomograms using decision curve analysis (DCA) in both the training and validation cohorts, and ultimately constructed three online calculators based on these nomograms.
RESULTS
We identified ASA, diabetes, smoking, and lymph node invasion as predisposing risk factors for postoperative complications, and the predictive factors that affected both OS and CSS were ASA, diabetes, BMI, CA19-9 level, and tumor diameter. By integrating the above risk factors, we constructed three nomograms on postoperative complication, CSS, and OS. The C-index for complication, CSS, and OS were 0.824, 0.784, and 0.801 in the training cohort and 0.746, 0.718, and 0.708 in the validation cohort. Moreover, the validation curves and DCA demonstrated good calibration and robust compliance in both training and validation cohorts. We then developed three web calculators (https://caiming.shinyapps.io/CMCD/, https://caiming.shinyapps.io/CMCSS/, and https://caiming.shinyapps.io/CMOS/) to facilitate the use of the nomograms.
CONCLUSIONS
The calculators demonstrated promising performance as an tool for predicting the safety and efficacy of PD in elderly PHC patients.
背景
受益于预期寿命的延长和围手术期管理的改善，越来越多的老年胰头癌（PHC）患者接受了胰十二指肠切除术（PD）。然而，针对 PD 的安全性和疗效的个体化预测模型仍然缺乏。本研究旨在为老年（≥65 岁）PHC 患者开发三种与安全性和疗效相关的风险计算器。
方法
本研究采用了两个研究队列，即训练队列和验证队列，包括四个一般步骤：（1）使用逻辑回归和 Cox 回归分析，在训练队列（N=271）中分析术后并发症、癌症特异性生存（CSS）和总体生存（OS）发生率的相关风险因素。（2）基于上述结果绘制列线图。（3）使用一致性指数（C 指数）和校准曲线，使用验证队列（N=134）数据验证开发的列线图模型的准确性。（4）然后，使用决策曲线分析（DCA）在训练和验证队列中评估这些列线图的疗效，并最终基于这些列线图构建三个在线计算器。
结果
我们确定 ASA、糖尿病、吸烟和淋巴结侵犯是术后并发症的易患风险因素，影响 OS 和 CSS 的预测因素是 ASA、糖尿病、BMI、CA19-9 水平和肿瘤直径。通过整合上述风险因素，我们构建了术后并发症、CSS 和 OS 的三个列线图。训练队列中并发症、CSS 和 OS 的 C 指数分别为 0.824、0.784 和 0.801，验证队列中分别为 0.746、0.718 和 0.708。此外，验证曲线和 DCA 在训练和验证队列中均显示出良好的校准和稳健性。然后，我们开发了三个网络计算器（https://caiming.shinyapps.io/CMCD/，https://caiming.shinyapps.io/CMCSS/，和 https://caiming.shinyapps.io/CMOS/），以方便列线图的使用。
结论
这些计算器作为预测老年 PHC 患者 PD 安全性和疗效的工具具有良好的性能。
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