Zheng Binjiao, Ding Gangfeng, Lu Guangrong, Li Lili
School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China.
The First Clinical Medical College of Wenzhou Medical University, Wenzhou, China.
Transl Cancer Res. 2024 Jun 30;13(6):2751-2766. doi: 10.21037/tcr-24-5. Epub 2024 Jun 13.
Pancreatic ductal adenocarcinoma (PDAC), which accounts for the vast majority of pancreatic cancer (PC), is a highly aggressive malignancy with a dismal prognosis. Age is shown to be an independent factor affecting survival outcomes in patients with PDAC. Our study aimed to identify prognostic factors and construct a nomogram to predict survival in PDAC patients aged ≥60 years.
Data of PDAC patients aged ≥60 years were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate Cox regression analysis was used to determined prognostic factors of overall survival (OS) and cancer-specific survival (CSS), and two nomograms were constructed and validated by calibration plots, concordance index (C-index) and decision curve analysis (DCA). Additionally, 432 patients from the First Affiliated Hospital of Wenzhou Medical University were included as an external cohort. Kaplan-Meier curves were applied to further verify the clinical validity of the nomograms.
Ten independent prognostic factors were identified to establish the nomograms. The C-indexes of the training and validation groups based on the OS nomogram were 0.759 and 0.760, higher than those of the tumor-node-metastasis (TNM) staging system (0.638 and 0.636, respectively). Calibration curves showed high consistency between predictions and observations. Better area under the receiver operator characteristic (ROC) curve (AUC) values and DCA were also obtained compared to the TNM system. The risk stratification based on the nomogram could distinguish patients with different survival risks.
We constructed and externally validated a population-based survival-predicting nomogram for PDAC patients aged ≥60 years. The new model could help clinicians personalize survival prediction and risk assessment.
胰腺导管腺癌（PDAC）占胰腺癌（PC）的绝大多数，是一种侵袭性很强的恶性肿瘤，预后很差。年龄被证明是影响PDAC患者生存结果的独立因素。我们的研究旨在确定预后因素并构建列线图，以预测年龄≥60岁的PDAC患者的生存情况。
从监测、流行病学和最终结果（SEER）数据库中收集年龄≥60岁的PDAC患者的数据。采用多变量Cox回归分析确定总生存（OS）和癌症特异性生存（CSS）的预后因素，并通过校准图、一致性指数（C指数）和决策曲线分析（DCA）构建并验证两个列线图。此外，纳入温州医科大学附属第一医院的432例患者作为外部队列。应用Kaplan-Meier曲线进一步验证列线图的临床有效性。
确定了10个独立的预后因素以建立列线图。基于OS列线图的训练组和验证组的C指数分别为0.759和0.760，高于肿瘤-淋巴结-转移（TNM）分期系统（分别为0.638和0.636）。校准曲线显示预测值与观察值之间具有高度一致性。与TNM系统相比，还获得了更好的受试者操作特征曲线（ROC）下面积（AUC）值和DCA。基于列线图的风险分层可以区分具有不同生存风险的患者。
我们构建并对外验证了一个针对年龄≥60岁的PDAC患者的基于人群的生存预测列线图。新模型可以帮助临床医生进行个性化的生存预测和风险评估。
