Feng Yuan, Yang Junjun, Duan Wentao, Cai Yu, Liu Xiaohong, Peng Yong
Department of Hepatobiliary Pancreatic and Spleen Surgery, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China.
Front Oncol. 2024 Jan 15;13:1336251. doi: 10.3389/fonc.2023.1336251. eCollection 2023.
This study aimed to develop a prognostic model for patients with advanced ductal adenocarcinoma aged ≥50 years.
Patient information was extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Least absolute shrinkage and selection operator (LASSO) Cox regression analysis was performed to screen the model variables. Cases from Nanchang Central Hospital were collected for external validation. The new nomogram and the American Joint Committee on Cancer (AJCC) criteria were evaluated using integrated discrimination improvement (IDI) and net reclassification index (NRI) indicators. Survival curves presented the prognosis of the new classification system and AJCC criteria.
In total, 17,621 eligible patients were included. Lasso Cox regression selected 4 variables including age, chemotherapy, radiotherapy and AJCC stage. The C-index of the training cohort was 0.721. The C-index value of the validation cohort was 0.729. The AUCs for the training cohorts at 1, 2, and 3 years were 0.749, 0.729, and 0.715, respectively. The calibration curves showed that the predicted and actual probabilities at 1, 2, and 3 years matched. External validation confirmed the model's outstanding predictive power. Decision curve analysis indicated that the clinical benefit of the nomogram was higher than that of the AJCC staging system. The model evaluation indices preceded the AJCC staging with NRI (1-year: 0.88, 2-year: 0.94, 3-year: 0.72) and IDI (1-year: 0.24, 2-year: 0.23, 3-year: 0.22). The Kaplan-Meier curves implied that the new classification system was more capable of distinguishing between patients at different risks.
This study established a prognostic nomogram and risk classification system for advanced pancreatic cancer in patients aged ≥50 years to provide a practical tool for the clinical management of patients with pancreatic ductal adenocarcinoma.
本研究旨在为年龄≥50岁的晚期导管腺癌患者建立一种预后模型。
从监测、流行病学和最终结果（SEER）数据库中提取患者信息。进行最小绝对收缩和选择算子（LASSO）Cox回归分析以筛选模型变量。收集南昌市中心医院的病例进行外部验证。使用综合判别改善（IDI）和净重新分类指数（NRI）指标评估新的列线图和美国癌症联合委员会（AJCC）标准。生存曲线呈现了新分类系统和AJCC标准的预后情况。
总共纳入了17621例符合条件的患者。Lasso Cox回归选择了4个变量，包括年龄、化疗、放疗和AJCC分期。训练队列的C指数为0.721。验证队列的C指数值为0.729。训练队列在1年、2年和3年时的AUC分别为0.749、0.729和0.715。校准曲线表明1年、2年和3年时的预测概率与实际概率相匹配。外部验证证实了该模型出色的预测能力。决策曲线分析表明列线图的临床获益高于AJCC分期系统。该模型评估指标在NRI（1年：0.88，2年：0.94，3年：0.72）和IDI（1年：0.24，2年：0.23，3年：0.22）方面优于AJCC分期。Kaplan-Meier曲线表明新分类系统更能区分不同风险的患者。
本研究为年龄≥50岁的晚期胰腺癌患者建立了一种预后列线图和风险分类系统，为胰腺导管腺癌患者的临床管理提供了一种实用工具。
