Engineering Research Center for New Materials and Precision Treatment Technology of Malignant Tumors Therapy, The Second Affiliated Hospital, Dalian Medical University, Dalian, Liaoning, China.
Engineering Technology Research Center for Translational Medicine, The Second Affiliated Hospital, Dalian Medical University, Dalian, Liaoning, China.
Sci Rep. 2024 Aug 5;14(1):18136. doi: 10.1038/s41598-024-69126-8.
The purpose of this study was to compare the predictive value of different lymph node staging systems and to develop an optimal prognostic nomogram for predicting distant metastasis in pancreatic ductal adenocarcinoma (PDAC). Our study involved 6364 patients selected from the Surveillance, Epidemiology, and End Results (SEER) database and 126 patients from China. Independent risk factors for distant metastasis were screened by univariate and multivariate logistic regression analyses, and a model-based comparison of different lymph node staging systems was conducted. Furthermore, we developed a nomogram for predicting distant metastasis using the optimal performance lymph node staging system. The lymph node ratio (LNR), log odds of positive lymph nodes (LODDS), age, primary site, grade, tumor size, American Joint Committee on Cancer (AJCC) 7th Edition T stage, and radiotherapy recipient status were significant predictors of distant metastasis in PDAC patients. The model with the LODDS was a better fit than the model with the LNR. We developed a nomogram model based on LODDS and six clinical parameters. The area under the curve (AUC) and concordance index (C-index) of 0.753 indicated that this model satisfied the discrimination criteria. Kaplan-Meier curves indicate a significant difference in OS among patients with different metastasis risks. LODDS seems to have a superior ability to predict distant metastasis in PDAC patients compared with the AJCC 8th Edition N stage, PLN and LNR staging systems. Moreover, we developed a nomogram model for predicting distant metastasis. Clinicians can use the model to detect patients at high risk of distant metastasis and to make further clinical decisions.
本研究旨在比较不同的淋巴结分期系统的预测价值,并为预测胰腺导管腺癌(PDAC)的远处转移开发最佳的预后列线图。我们的研究涉及从监测、流行病学和最终结果(SEER)数据库中选择的 6364 名患者和来自中国的 126 名患者。通过单因素和多因素逻辑回归分析筛选出远处转移的独立危险因素,并对不同的淋巴结分期系统进行基于模型的比较。此外,我们使用最佳性能的淋巴结分期系统开发了用于预测远处转移的列线图。淋巴结比率(LNR)、对数阳性淋巴结比值(LODDS)、年龄、原发部位、分级、肿瘤大小、美国癌症联合委员会(AJCC)第 7 版 T 分期和放疗接受者状态是 PDAC 患者远处转移的显著预测因素。LODDS 模型比 LNR 模型更适合。我们基于 LODDS 和六个临床参数开发了一个列线图模型。曲线下面积(AUC)和一致性指数(C-index)为 0.753,表明该模型满足区分标准。Kaplan-Meier 曲线表明,不同转移风险的患者之间的 OS 存在显著差异。与 AJCC 第 8 版 N 分期、PLN 和 LNR 分期系统相比,LODDS 似乎更能预测 PDAC 患者的远处转移。此外,我们开发了一个用于预测远处转移的列线图模型。临床医生可以使用该模型检测远处转移风险较高的患者,并做出进一步的临床决策。
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