Risk factors, prognostic factors, and nomograms for distant metastasis in patients with diagnosed duodenal cancer: A population-based study

Abstract

Background: Duodenal cancer is one of the most common subtypes of small intestinal cancer, and distant metastasis (DM) in this type of cancer still leads to poor prognosis. Although nomograms have recently been used in tumor areas, no studies have focused on the diagnostic and prognostic evaluation of DM in patients with primary duodenal cancer.

Aim: To develop and evaluate nomograms for predicting the risk of DM and personalized prognosis in patients with duodenal cancer.

Methods: Data on duodenal cancer patients diagnosed between 2010 and 2019 were extracted from the Surveillance, Epidemiology, and End Results database. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for DM in patients with duodenal cancer, and univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors in duodenal cancer patients with DM. Two novel nomograms were established, and the results were evaluated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

Results: A total of 2603 patients with duodenal cancer were included, of whom 457 cases (17.56%) had DM at the time of diagnosis. Logistic analysis revealed independent risk factors for DM in duodenal cancer patients, including gender, grade, tumor size, T stage, and N stage (P < 0.05). Univariate and multivariate COX analyses further identified independent prognostic factors for duodenal cancer patients with DM, including age, histological type, T stage, tumor grade, tumor size, bone metastasis, chemotherapy, and surgery (P < 0.05). The accuracy of the nomograms was validated in the training set, validation set, and expanded testing set using ROC curves, calibration curves, and DCA curves. The results of Kaplan-Meier survival curves (P < 0.001) indicated that both nomograms accurately predicted the occurrence and prognosis of DM in patients with duodenal cancer.

Conclusion: The two nomograms are expected as effective tools for predicting DM risk in duodenal cancer patients and offering personalized prognosis predictions for those with DM, potentially enhancing clinical decision-making.

Keywords: Distant metastasis; Duodenal cancer; Nomogram; Prognostic factors; Risk factors.

Figure 1

Construction and validation of a diagnostic nomogram. A: A nomogram to estimate the risk of distant metastasis in duodenal carcinoma patients; B: The receiver operating characteristic curve of the training set; C: The calibration curve of the training set; D: The decision curve analysis of the training set; E: The receiver operating characteristic curve of the validation set; F: The calibration curve of the validation set; G: The decision curve analysis of the validation set. AUC: Area under the curve.

Figure 2

Comparison of area under the receiver operating characteristic curves between nomogram and all independent factors, including Grade, T stage, N stage, Size and Sex. A: In the training set; B: In the validation set.

Figure 3

Validating the diagnostic nomogram in the expanded testing set. A: The receiver operating characteristic curve of the expanded testing set; B: The calibration curve of the expanded testing set; C: The decision curve analysis of the expanded testing set; D: Comparison of area under the receiver operating characteristic curves between nomogram and all independent factors, including sex, T stage, tumor size, grade stage.

Figure 4

A prognostic nomogram for predicting the overall survival of duodenal carcinoma patients with distant metastasis for the 12, 36, and 60 months.

Figure 5

Calibration and decision curves for 12, 36, and 60 months in the training set. A: The calibration curves of the nomogram for the 12 months in the training set; B: The calibration curves of the nomogram for the 36 months in the training set; C: The calibration curves of the nomogram for the 60 months in the training set; D: The decision curve analysis of the nomogram for the 12 months in the training set; E: The decision curve analysis of the nomogram for the 36 months in the training set; F: The decision curve analysis of the nomogram for the 60 months in the training set.

Figure 6

Calibration and decision curve analysis for nomogram at 12, 36, and 60 months in the validation set. A: The calibration curves of the nomogram for the 12 months in the validation set; B: The calibration curves of the nomogram for the 36 months in the validation set; C: The calibration curves of the nomogram for the 60 months in the validation set; D: The decision curve analysis of the nomogram for the 12 months in the validation set; E: The decision curve analysis of the nomogram for the 36 months in the validation set; F: The decision curve analysis of the nomogram for the 60 months in the validation set.

Figure 7

Time-dependent receiver operating characteristic curve analysis and kaplan-meier survival curves in the training and validation sets. A: Time-dependent receiver operating characteristic curve analysis of the nomogram for the 12, 36, and 60 months in the training set; B: Time-dependent receiver operating characteristic curve analysis of the nomogram for the 12, 36, and 60 months in the validation set; C: The Kaplan-Meier (K-M) survival curves of the patients in the training set; D: The K-M survival curves of the patients in the validation set.

Figure 8

Comparison of area under the receiver operating characteristic curves between nomogram and all independent factors, including age, T stage, tumor size, grade stage, bone metastasis, surgery, and chemotherapy. A: 12 months in the training set; B: 36 months in the training set; C: 60 months in the training set; D: 12 months in the validation set; E: 36 months in the validation set; F: 60 months in the validation set.

Figure 9

Validating the prognostic nomogram in the expanded testing set. A: The calibration curves of the nomogram for the 12 months in the expanded testing set; B: The calibration curves of the nomogram for the 36 months in the expanded testing set; C: The calibration curves of the nomogram for the 60 months in the expanded testing set; D: The decision curve analysis of the nomogram for the 12 months in the expanded testing set; E: The decision curve analysis of the nomogram for the 36 months in the expanded testing set; F: The decision curve analysis of the nomogram for the 60 months in the expanded testing set; G: Comparison of area under the receiver operating characteristic curves between nomogram and all independent factors for the 12 months in the expanded testing set; H: Comparison of area under the receiver operating characteristic curves between nomogram and all independent factors for the 36 months in the expanded testing set; I: Comparison of area under the receiver operating characteristic curves between nomogram and all independent factors for the 60 months in the expanded testing set; J: Time-dependent receiver operating characteristic curve analysis of the nomogram for the 12, 36, and 60 months in the expanded testing set; K: The Kapla-Meier survival curve of the patients in the expanded testing set. AUC: Area under the curve.