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Multicenter Study
. 2023 Aug;128(2):280-288.
doi: 10.1002/jso.27287. Epub 2023 Apr 19.

Accuracy of models to prognosticate survival after surgery for pancreatic cancer in the era of neoadjuvant therapy

Clayton T Marcinak  1 , William F Parker  2 , Alexander A Parikh  3 , Jashodeep Datta  4 , Shishir K Maithel  5 , David A Kooby  5 , Mark E Burkard  6 , Hong Jin Kim  7 , Michael T LeCompte  7 , Majid Afshar  8 , Matthew M Churpek  8 , Syed Nabeel Zafar  1
Affiliations
Multicenter Study

Accuracy of models to prognosticate survival after surgery for pancreatic cancer in the era of neoadjuvant therapy

Clayton T Marcinak et al. J Surg Oncol. 2023 Aug.

Abstract

Background: Outcomes for pancreatic adenocarcinoma (PDAC) remain difficult to prognosticate. Multiple models attempt to predict survival following the resection of PDAC, but their utility in the neoadjuvant population is unknown. We aimed to assess their accuracy among patients that received neoadjuvant chemotherapy (NAC).

Methods: We performed a multi-institutional retrospective analysis of patients who received NAC and underwent resection of PDAC. Two prognostic systems were evaluated: the Memorial Sloan Kettering Cancer Center Pancreatic Adenocarcinoma Nomogram (MSKCCPAN) and the American Joint Committee on Cancer (AJCC) staging system. Discrimination between predicted and actual disease-specific survival was assessed using the Uno C-statistic and Kaplan-Meier method. Calibration of the MSKCCPAN was assessed using the Brier score.

Results: A total of 448 patients were included. There were 232 (51.8%) females, and the mean age was 64.1 years (±9.5). Most had AJCC Stage I or II disease (77.7%). For the MSKCCPAN, the Uno C-statistic at 12-, 24-, and 36-month time points was 0.62, 0.63, and 0.62, respectively. The AJCC system demonstrated similarly mediocre discrimination. The Brier score for the MSKCCPAN was 0.15 at 12 months, 0.26 at 24 months, and 0.30 at 36 months, demonstrating modest calibration.

Conclusions: Current survival prediction models and staging systems for patients with PDAC undergoing resection after NAC have limited accuracy.

Keywords: calibration; nomograms; pancreatectomy; pancreatic carcinoma; pancreatic neoplasms; prognosis.

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Conflict of interest statement

Conflicts of Interest:

M.M.C. holds U.S. Patent #11,410,777 and receives royalties paid by the University of Chicago related to an algorithm for risk stratification of hospitalized patients. M.E.B. serves on the medical advisory board of Strata Oncology. M.E.B. receives research funding from Abbvie, Arcus, Apollomics, Elevation Oncology, Endeavor, Genetech, Puma, Loxo Oncology, and Seagen.

Figures

Figure 1:
Figure 1:. Kaplan-Meier curve for overall survival (OS) of cohort.
Dashed vertical line indicates median survival. Shading represents 95% confidence interval.
Figure 2:
Figure 2:. Kaplan-Meier curves for disease-specific survival (DSS) based on MSKCCPAN risk groups.
Dashed vertical lines indicate median survival.
Figure 3:
Figure 3:. Kaplan-Meier curves for disease-specific survival (DSS) based on AJCC stage.
Dashed vertical lines indicate median survival.
Figure 4:
Figure 4:. Calibration plots for MSKCCPAN at (a) 12 months, (b) 24 months, and (c) 36 months.
Vertical bars represent 95% confidence interval. Diagonal line represents perfect calibration.
See this image and copyright information in PMC

References

    1. National Cancer Institute (NCI). Pancreatic Cancer – Cancer Stat Facts. NCI Surveillance, Epidemiology, and End Results Program (SEER) 2021; https://seer.cancer.gov/statfacts/html/pancreas.html. Accessed December 16, 2021.
    1. Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting Cancer Incidence and Deaths to 2030: The Unexpected Burden of Thyroid, Liver, and Pancreas Cancers in the United States. Cancer Res. 2014;74(11):2913. - PubMed
    1. Katz MHG, Wang H, Fleming JB, et al. Long-Term Survival After Multidisciplinary Management of Resected Pancreatic Adenocarcinoma. Ann Surg Oncol. 2009;16(4):836. - PMC - PubMed
    1. O’Shea AE, Bohan PMK, Carpenter EL, et al. Downstaging of Pancreatic Adenocarcinoma With Either Neoadjuvant Chemotherapy or Chemoradiotherapy Improves Survival. Ann Surg Oncol. 2022. - PubMed
    1. Wu C, Hou SZ, Wu Z, Huang X, Wang Z, Tian B. Prognostic Nomogram for patients undergoing radical Pancreaticoduodenectomy for adenocarcinoma of the pancreatic head. BMC Cancer. 2021;21(1):624. - PMC - PubMed

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