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. 2021 May 27;12(14):4433-4442.
doi: 10.7150/jca.57768. eCollection 2021.

A novel risk-scoring system conducing to chemotherapy decision for patients with pancreatic ductal adenocarcinoma after pancreatectomy

Yuqiang Li  1   2 , Mengxiang Tian  1 , Yuan Zhou  1 , Fengbo Tan  1 , Wenxue Liu  3   4 , Lilan Zhao  5 , Daniel Perez  2 , Xiangping Song  1 , Dan Wang  1   2 , Christine Nitschke  2 , Qian Pei  1 , Cenap Güngör  2
Affiliations

A novel risk-scoring system conducing to chemotherapy decision for patients with pancreatic ductal adenocarcinoma after pancreatectomy

Yuqiang Li et al. J Cancer. .

Abstract

Background: Chemotherapy is suggested to use in all stages of pancreatic cancer. Is it reasonable to recommend chemotherapy for all PDAC patients? It is necessary to distinguish low-risk PDAC patients underwent pancreatectomy, who may not lose survival time due to missed chemotherapy and not need to endure pain, nausea, tiredness, drowsiness, and breath shortness caused by chemotherapy. Methods: Nomograms were constructed with basis from the multivariate Cox regression analysis. X-tile software was utilized to perform risk stratification. Survival curves were used to display the effect of chemotherapy in different risk-stratification. Results: All of the significant variables were used to create the nomograms for overall survival (OS). The total risk score of each patient was calculated by summing the scores related to each variable. X-tile software was utilized to classify patients into high-risk (score >283), median-risk (197<score ≤283), and low-risk (score ≤197) according to the total risk score. The low-risk PDAC patients after pancreatectomy cannot gain survival benefit from chemotherapy after surgery (p=0.443). Moreover, chemotherapy improved survival for patients with resected PDAC in the median-risk (p<0.001) and high-risk (p<0.001) groups. Conclusions: our research constructed a new risk-scoring system based on survival nomogram to screen low-risk PDAC patients after pancreatectomy and confirmed that those can avoid enduring side effects caused by chemotherapy without affecting the survival time.

Keywords: PDAC; SEER database; chemotherapy; nomogram; surgical resection.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
The flow chart.
Figure 2
Figure 2
Construction and verification of the nomogram. A: The nomogram predicting OS for resectable PDAC patients with chemotherapy. B: The calibration curves predicting OS at 1-year, 3-year, 5-year in training group. C: The calibration curves predicting OS at 1-year, 3-year, 5-year in verification group. D: The AUC values of time- dependent ROC curves regarding nomogram predicting 1-year, 3-year, 5-year OS in training group. E: The AUC values of time- dependent ROC curves regarding nomogram predicting 1-year, 3-year, 5-year OS in verification group. F: The decision curve analysis displayed the obvious advantages of the nomogram comparing with the other indicators in training group. G: The decision curve analysis displayed the obvious advantages of the nomogram comparing with the other indicators in verification group.
Figure 3
Figure 3
The calibration curve (A), time-dependent ROC curve (B), and DCA curve (C) showed favorable effects in resectable PDAC patients without chemotherapy.
Figure 4
Figure 4
The correspondence between our risk stratification and the AJCC staging. A: The correspondence between our risk stratification and the AJCC staging in PDAC patients with chemotherapy. B: The correspondence between our risk stratification and the AJCC staging in PDAC patients without chemotherapy.
Figure 5
Figure 5
The survival differences between chemotherapy and non-chemotherapy in each risk stratification. A: The survival differences between chemotherapy and non-chemotherapy in PDAC patients with low-risk (p=0.443). B: The survival differences between chemotherapy and non-chemotherapy in PDAC patients with median-risk (p<0.001). C: The survival differences between chemotherapy and non-chemotherapy in PDAC patients with high-risk (p<0.001).
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