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. 2022 Sep 23:12:998445.
doi: 10.3389/fonc.2022.998445. eCollection 2022.

Risk factors and predictive nomograms for early death of patients with pancreatic cancer liver metastasis: A large cohort study based on the SEER database and Chinese population

Haidong Zhang  1 , Hui Dong  1 , Zheng Pan  2 , Xuanlong Du  1 , Shiwei Liu  1 , Wenjing Xu  1 , Yewei Zhang  3
Affiliations

Risk factors and predictive nomograms for early death of patients with pancreatic cancer liver metastasis: A large cohort study based on the SEER database and Chinese population

Haidong Zhang et al. Front Oncol. .

Abstract

Background: The liver is the most common organ for distant metastasis of pancreatic cancer, and patients with pancreatic cancer liver metastases (PCLM) often die in a short period of time. As such, the establishment of an effective nomogram to predict the probability of early death (survival time ≤3 months) in PCLM patients is of considerable significance.

Methods: Patients diagnosed with PCLM in the Surveillance, Epidemiology, and End Result (SEER) database between 2010 and 2015 were included for model construction and internal validation. A data set was obtained from the Chinese population for external validation. Risk factors that contributed to all-cause and cancer-specific early death were determined by means of univariable and multivariable logistic regression. The accuracy of the nomogram was verified by means of receiver operating characteristic (ROC) curves, and the true consistency of the model was assessed by calibration curves. The clinical applicability of the model was evaluated by means of decision curve analysis (DCA).

Results: A total of 12,955 patients were included in the present study, of whom 7,219 (55.7%) experienced early death and 6,973 (53.8%) patients died of PCLM. Through multivariable logistic regression analysis, 11 risk factors associated with all-cause early death and 12 risk factors associated with cancer-specific early death were identified. The area under the curves (AUCs) for all-cause and cancer-specific early death were 0.806 (95% CI: 0.785- 0.827) and 0.808 (95% CI: 0.787- 0.829), respectively. Internal validation showed that the C-indexes of all-cause and cancer-specific early death after bootstrapping (5,000 re-samplings) were 0.805 (95% CI: 0.784-0.826) and 0.807 (95% CI: 0.786-0.828), respectively. As revealed by the calibration curves, the constructed nomograms exhibited good consistency. The decision curve analysis (DCA) indicated the nomograms had significant clinical applicability.

Conclusion: In the present study, reliable nomograms were developed for predicting the early death probability in patients with PCLM. Such tools can help clinicians identify high-risk patients and develop individualized treatment plans as early as possible.

Keywords: SEER database; early death; liver metastasis; nomogram; pancreatic cancer.

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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
The flowchart of patient selection from SEER database.
Figure 2
Figure 2
The predictive nomogram for (A) all-cause early death and (B) cancer-specific early death of pancreatic cancer liver metastasis patients in the SEER database.
Figure 3
Figure 3
ROC curves for the nomogram. (A) The ROC curve for the all-cause early death nomogram in the SEER database; (B) The ROC curve for the cancer-specific early death nomogram in the SEER database.
Figure 4
Figure 4
Calibration plots for the nomogram of (A) all-cause early death in the SEER database; (B) cancer-specific early death in the SEER database.
Figure 5
Figure 5
Decision curve analysis (DCA) for the nomogram of (A) all-cause early death in the SEER database; (B) cancer-specific early death in the SEER database.
Figure 6
Figure 6
Validation in Chinese population. (A) The ROC curve for the nomogram; (B) The calibration plots for the nomogram.
Figure 7
Figure 7
A web-based probability calculator. The graphical summary showed a rough range of (A) all-cause and (B) cancer-specific early death probability and its 95% confidence interval.
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