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. 2024 Jan 1;279(1):132-137.
doi: 10.1097/SLA.0000000000006004. Epub 2023 Jul 17.

Predicting Long-term Disease-free Survival After Resection of Pancreatic Ductal Adenocarcinoma: A Nationwide Cohort Study

Iris W J M van Goor  1   2 , Thijs J Schouten  1 , Daphne N Verburg  1 , Marc G Besselink  3   4 , Bert A Bonsing  5 , Koop Bosscha  6 , Lodewijk A A Brosens  7 , Olivier R Busch  3   4 , Geert A Cirkel  8 , Ronald M van Dam  9 , Sebastiaan Festen  10 , Bas Groot Koerkamp  11 , Erwin van der Harst  12 , Ignace H J T de Hingh  13 , Martijn P W Intven  2 , Geert Kazemier  4   14 , Maartje Los  15 , Gert J Meijer  2 , Vincent E de Meijer  16 , Vincent B Nieuwenhuijs  17 , Daphne Roos  18 , Jennifer M J Schreinemakers  19 , Martijn W J Stommel  20 , Robert C Verdonk  21 , Hjalmar C van Santvoort  1 , Lois A Daamen  1   22 , I Quintus Molenaar  1 ; Dutch Pancreatic Cancer Group
Affiliations

Predicting Long-term Disease-free Survival After Resection of Pancreatic Ductal Adenocarcinoma: A Nationwide Cohort Study

Iris W J M van Goor et al. Ann Surg. .

Abstract

Objective: To develop a prediction model for long-term (≥5 years) disease-free survival (DFS) after the resection of pancreatic ductal adenocarcinoma (PDAC).

Background: Despite high recurrence rates, ~10% of patients have long-term DFS after PDAC resection. A model to predict long-term DFS may aid individualized prognostication and shared decision-making.

Methods: This nationwide cohort study included all consecutive patients who underwent PDAC resection in the Netherlands (2014-2016). The best-performing prognostic model was selected by Cox-proportional hazard analysis and Akaike's Information Criterion, presented by hazard ratios (HRs) with 95% confidence intervals (CIs). Internal validation was performed, and discrimination and calibration indices were assessed.

Results: In all, 836 patients with a median follow-up of 67 months (interquartile range 51-79) were analyzed. Long-term DFS was seen in 118 patients (14%). Factors predictive of long-term DFS were low preoperative carbohydrate antigen 19-9 (logarithmic; HR 1.21; 95% CI 1.10-1.32), no vascular resection (HR 1.33; 95% CI 1.12-1.58), T1 or T2 tumor stage (HR 1.52; 95% CI 1.14-2.04, and HR 1.17; 95% CI 0.98-1.39, respectively), well/moderate tumor differentiation (HR 1.44; 95% CI 1.22-1.68), absence of perineural and lymphovascular invasion (HR 1.42; 95% CI 1.11-1.81 and HR 1.14; 95% CI 0.96-1.36, respectively), N0 or N1 nodal status (HR 1.92; 95% CI 1.54-2.40, and HR 1.33; 95% CI 1.11-1.60, respectively), R0 resection margin status (HR 1.25; 95% CI 1.07-1.46), no major complications (HR 1.14; 95% CI 0.97-1.35) and adjuvant chemotherapy (HR 1.74; 95% CI 1.47-2.06). Moderate performance (concordance index 0.68) with adequate calibration (slope 0.99) was achieved.

Conclusions: The developed prediction model, readily available at www.pancreascalculator.com, can be used to estimate the probability of long-term DFS after resection of pancreatic ductal adenocarcinoma.

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Figures

FIGURE 1
FIGURE 1
Nomogram to predict the probability of disease-free survival of ≥ 5 years for individual patients after resection of pancreatic ductal adenocarcinoma.
See this image and copyright information in PMC

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