Medical Faculty of Ludwig Maximilians University of Munich, University Hospital of LMU Munich, Munich, Germany.
Department of Gastroenterology and Digestive Endoscopy Center, The Second Hospital of Jilin University, Changchun, China.
Cancer Invest. 2024 Apr;42(4):333-344. doi: 10.1080/07357907.2024.2349585. Epub 2024 May 7.
There is a controversy about whether surgery should proceed among metastatic pancreatic cancer (mPC) patients. A survival benefit was observed in mPC patients who underwent primary tumor resection; however, determining which patients would benefit from surgery is complex. For this purpose, we created a model to identify mPC patients who may benefit from primary tumor excision.
Patients with mPC were extracted from the Surveillance, Epidemiology, and End Results database, and separated into surgery and nonsurgery groups based on whether the primary tumor was resected. Propensity score matching (PSM) was applied to balance confounding factors between the two groups. A nomogram was developed using multivariable logistic regression to estimate surgical benefit. Our model is evaluated using multiple methods.
About 662 of 14,183 mPC patients had primary tumor surgery. Kaplan-Meier analyses showed that the surgery group had a better prognosis. After PSM, a survival benefit was still observed in the surgery group. Among the surgery cohort, 202 patients survived longer than 4 months (surgery-beneficial group). The nomogram discriminated better in training and validation sets under the receiver operating characteristic (ROC) curve (AUC), and calibration curves were consistent. Decision curve analysis (DCA) revealed that it was clinically valuable. This model is better at identifying candidates for primary tumor excision.
A helpful prediction model was developed and validated to identify ideal candidates who may benefit from primary tumor resection in mPC.
转移性胰腺癌（mPC）患者是否应进行手术存在争议。mPC 患者行原发肿瘤切除术可观察到生存获益；然而，确定哪些患者将从手术中获益是复杂的。为此，我们创建了一个模型来识别可能从原发肿瘤切除中获益的 mPC 患者。
从监测、流行病学和最终结果数据库中提取 mPC 患者，并根据是否切除原发肿瘤将其分为手术组和非手术组。应用倾向评分匹配（PSM）来平衡两组之间的混杂因素。使用多变量逻辑回归建立列线图来估计手术获益。我们的模型采用多种方法进行评估。
约 14183 例 mPC 患者中有 662 例接受了原发肿瘤手术。Kaplan-Meier 分析显示手术组预后更好。PSM 后，手术组仍观察到生存获益。在手术组中，202 例患者存活时间超过 4 个月（手术获益组）。列线图在接受者操作特征（ROC）曲线下的训练和验证集(AUC)中具有更好的区分能力，校准曲线一致。决策曲线分析（DCA）表明其具有临床价值。该模型更善于识别适合原发肿瘤切除的候选者。
我们开发并验证了一个有帮助的预测模型，以识别可能从 mPC 原发肿瘤切除中获益的理想候选者。
