Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China.
Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China.
Eur J Surg Oncol. 2024 Jul;50(7):108355. doi: 10.1016/j.ejso.2024.108355. Epub 2024 Apr 17.
We sought to combine skeletal muscle index and inflammatory immune markers to stratify long-term survival in patients with pancreatic cancer after pancreatoduodenectomy (PD).
A total of 581 patients with pancreatic cancer underwent PD were included, and divided into the training and validation cohort. Image analysis of computed tomography scans was used to calculate the ratio of skeletal muscle (SM) area to body mass index (BMI). Naples prognostic score (NPS) was calculated from blood-test inflammatory immune markers. Propensity score matching (PSM) analysis was performed to minimize biases of clinicopathological characteristics. To estimate the overall survival (OS), a nomogram was developed using the training cohort. The predictive accuracy of nomogram was estimated by concordance index (C-index), calibration curve, and receiver operating characteristics (ROC) curve.
After PSM analysis, SM/BMI ratio, NPS, lymph node metastasis, TNM stage, surgical margin, tumor grade and adjuvant therapy were independent predictors of OS, which were all assembled into nomogram. The SM/BMI ratio was the best single-predictor for 3- and 5-year OS, with an AUC of 0.805 (95% CI: 0.755-0.855) and 0.812 (95% CI: 0.736-0.888), respectively. Harrell's c-index of the nomogram in the training cohort was 0.786 (95% CI: 0.770-0.802), and the area under ROC curve of 1-year, 3- and 5-year OS prediction were 0.869 (95%CI: 0.837-0.901), 0.846 (95%CI: 0.810-0.882) and 0.849 (95%CI: 0.801-0.896).
The nomogram based on SM/BMI ratio and NPS had excellent predictive performance, which should be incorporated to conventional risk scores to stratify survival of patients with PDAC after PD.
我们试图结合骨骼肌指数和炎症免疫标志物来对胰十二指肠切除术（PD）后胰腺癌患者进行长期生存分层。
共纳入 581 例胰腺癌患者行 PD，分为训练队列和验证队列。使用计算机断层扫描图像分析来计算骨骼肌（SM）面积与体重指数（BMI）的比值。从血液检测炎症免疫标志物中计算那不勒斯预后评分（NPS）。采用倾向评分匹配（PSM）分析以最小化临床病理特征的偏倚。使用训练队列开发列线图以估计总生存期（OS）。通过一致性指数（C 指数）、校准曲线和受试者工作特征（ROC）曲线来评估列线图的预测准确性。
PSM 分析后，SM/BMI 比值、NPS、淋巴结转移、TNM 分期、手术切缘、肿瘤分级和辅助治疗是 OS 的独立预测因素，这些因素均被纳入列线图。SM/BMI 比值是 3 年和 5 年 OS 的最佳单一预测因素，AUC 分别为 0.805（95%CI：0.755-0.855）和 0.812（95%CI：0.736-0.888）。训练队列中列线图的 Harrell's c 指数为 0.786（95%CI：0.770-0.802），1 年、3 年和 5 年 OS 预测的 ROC 曲线下面积分别为 0.869（95%CI：0.837-0.901）、0.846（95%CI：0.810-0.882）和 0.849（95%CI：0.801-0.896）。
基于 SM/BMI 比值和 NPS 的列线图具有出色的预测性能，应将其纳入常规风险评分，以对 PD 后行 PD 的 PDAC 患者的生存进行分层。
