TY - JOUR
T1 - Predicting Long-term Disease-free Survival After Resection of Pancreatic Ductal Adenocarcinoma
T2 - A Nationwide Cohort Study
AU - van Goor, Iris W J M
AU - Schouten, Thijs J
AU - Verburg, Daphne N
AU - Besselink, Marc G
AU - Bonsing, Bert A
AU - Bosscha, Koop
AU - Brosens, Lodewijk A A
AU - Busch, Olivier R
AU - Cirkel, Geert A
AU - van Dam, Ronald M
AU - Festen, Sebastiaan
AU - Koerkamp, Bas Groot
AU - van der Harst, Erwin
AU - de Hingh, Ignace H J T
AU - Intven, Martijn P W
AU - Kazemier, Geert
AU - Los, Maartje
AU - Meijer, Gert J
AU - de Meijer, Vincent E
AU - Nieuwenhuijs, Vincent B
AU - Roos, Daphne
AU - Schreinemakers, Jennifer M J
AU - Stommel, Martijn W J
AU - Verdonk, Robert C
AU - van Santvoort, Hjalmar C
AU - Daamen, Lois A
AU - Molenaar, I Quintus
AU - Dutch Pancreatic Cancer Group
PY - 2024/1/1
Y1 - 2024/1/1
N2 - OBJECTIVE: To develop a prediction model for long-term (=5 years) disease-free survival (DFS) after resection of pancreatic ductal adenocarcinoma (PDAC). SUMMARY BACKGROUND DATA: Despite high recurrence rates, approximately 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 ratio's (HR) with 95% confidence interval (CI). Internal validation was performed, and discrimination and calibration indices were assessed. RESULTS: 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; HR1.21; 95%CI 1.10-1.32), no vascular resection (HR1.33; 95%CI 1.12-1.58), T1 or T2 tumor stage (HR1.52; 95%CI 1.14-2.04, and HR1.17; 95%CI 0.98-1.39, respectively), well/moderate tumor differentiation (HR1.44; 95%CI 1.22-1.68), absence of perineural and lymphovascular invasion (HR1.42; 95%CI 1.11-1.81 and HR1.14; 95%CI 0.96-1.36, respectively), N0 or N1 nodal status (HR1.92; 95%CI 1.54-2.40, and HR1.33; 95%CI 1.11-1.60, respectively), R0 resection margin status (HR1.25; 95%CI 1.07-1.46), no major complications (HR1.14; 95%CI 0.97-1.35) and adjuvant chemotherapy (HR1.74; 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 disease-free survival after resection of pancreatic ductal adenocarcinoma.
AB - OBJECTIVE: To develop a prediction model for long-term (=5 years) disease-free survival (DFS) after resection of pancreatic ductal adenocarcinoma (PDAC). SUMMARY BACKGROUND DATA: Despite high recurrence rates, approximately 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 ratio's (HR) with 95% confidence interval (CI). Internal validation was performed, and discrimination and calibration indices were assessed. RESULTS: 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; HR1.21; 95%CI 1.10-1.32), no vascular resection (HR1.33; 95%CI 1.12-1.58), T1 or T2 tumor stage (HR1.52; 95%CI 1.14-2.04, and HR1.17; 95%CI 0.98-1.39, respectively), well/moderate tumor differentiation (HR1.44; 95%CI 1.22-1.68), absence of perineural and lymphovascular invasion (HR1.42; 95%CI 1.11-1.81 and HR1.14; 95%CI 0.96-1.36, respectively), N0 or N1 nodal status (HR1.92; 95%CI 1.54-2.40, and HR1.33; 95%CI 1.11-1.60, respectively), R0 resection margin status (HR1.25; 95%CI 1.07-1.46), no major complications (HR1.14; 95%CI 0.97-1.35) and adjuvant chemotherapy (HR1.74; 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 disease-free survival after resection of pancreatic ductal adenocarcinoma.
U2 - 10.1097/SLA.0000000000006004
DO - 10.1097/SLA.0000000000006004
M3 - Article
SN - 0003-4932
VL - 279
SP - 132
EP - 137
JO - Annals of Surgery
JF - Annals of Surgery
IS - 1
ER -