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. 2022 Aug 12:12:927107.
doi: 10.3389/fonc.2022.927107. eCollection 2022.

Development and external validation of a dynamic nomogram to predict the survival for adenosquamous carcinoma of the pancreas

Chao Ren  1   2 , Yifei Ma  2 , Jiabin Jin  3 , Jiachun Ding  2 , Yina Jiang  4 , Yinying Wu  5 , Wei Li  2 , Xue Yang  2 , Liang Han  2 , Qingyong Ma  2 , Zheng Wu  2 , Yusheng Shi  3 , Zheng Wang  2
Affiliations

Development and external validation of a dynamic nomogram to predict the survival for adenosquamous carcinoma of the pancreas

Chao Ren et al. Front Oncol. .

Abstract

Objective: We aimed to develop a nomogram to predict the survival and prognosis of adenosquamous carcinoma of the pancreas (ASCP).

Background: Adenosquamous carcinoma of the pancreas (ASCP) is a relatively rare histological subtype of pancreatic exocrine neoplasms. It was reported a worse survival in ASCP than in pancreatic adenocarcinoma (PDAC). Prediction of ASCP prognosis is of great importance.

Methods: Histologically confirmed ASCP patients from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program database were finally enrolled and divided into development and internal validation cohorts. Moreover, a multi-center cohort of 70 patients from China was registered as the external validation. A nomogram was developed based on independent predictors of ASCP determined in multivariable analysis.

Results: A total of 233 patients from SEER were finally included. Univariate and Multivariate analysis showed that tumor size, radiotherapy, chemotherapy, and lymph node ratio (LNR) were considered the independent prognostic indicators. We developed a nomogram according to these four parameters. The C index of the nomogram in the development cohort was 0.696. Through analysis of the area under the curve (AUC) of the different cohorts, we observed that the predictive efficacy of the nomogram for 1-, and 2-year overall survival (OS) were better than those of the American Joint Committee on Cancer (AJCC) TNM (8th) staging system both in the development and validation cohort. External validation confirmed that 1-year survival is 67.2% vs. 29.7%, similar to the internal cohort analysis.

Conclusion: The nomogram showed good performance in predicting the survival of ASCP. It could help surgeons to make clinical decisions and develop further plans.

Keywords: adenosquamous carcinoma; nomogram; pancreas; prognosis; the TNM 8th staging system.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) The nomogram for predicting the overall survival of patients with pancreatic adenosquamous carcinoma. (B–E) The 1-year and 2-year calibration curves of the development group and the internal verification group for prognostic nomogram of patients with pancreatic adenosquamous carcinoma (B) 1-year development group (C) 2-year development group (D) 1-year internal verification group (E) 2-year internal verification group.
Figure 2
Figure 2
(A–D) The 1-year and 2-year receiver-operating characteristic (ROC) curve of the development group and the internal verification group for the nomogram and AJCC TNM (8th) staging system of patients with pancreatic adenosquamous carcinoma. (A) 1-year development group (B) 2-year development group (C) 1-year internal verification group (D) 2-year internal verification group. (E, F) The 1-year and 2-year overall survival Decision Curve Analysis (DCA) of the nomogram and AJCC TNM (8th) staging system of patients with pancreatic adenosquamous carcinoma. (E) 1-year overall survival (F) 2-year overall survival. AJCC, American Joint Committee on Cancer.
Figure 3
Figure 3
(A–C): Kaplan-Miere analysis between different nomogram total scores predicting patients with pancreatic adenosquamous carcinoma in the (A): development cohort, (B): internal validation cohort, (C): external validation cohort.
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