Prognostic Nomogram for patients undergoing radical Pancreaticoduodenectomy for adenocarcinoma of the pancreatic head

Chao Wu, Sheng Zhong Hou, Zuowei Wu, Xing Huang, Zihe Wang, Bole Tian, Chao Wu, Sheng Zhong Hou, Zuowei Wu, Xing Huang, Zihe Wang, Bole Tian

Abstract

Background: Radical pancreaticoduodenectomy is the most common treatment strategy for patients diagnosed with adenocarcinoma of the pancreatic head. Few studies have reported the clinical characteristics and treatment efficacies of patients undergoing radical pancreaticoduodenectomy for adenocarcinoma of the pancreatic head.

Methods: A total of 177 pancreatic head cancer patients who underwent radical pancreaticoduodenectomy and were pathologically confirmed as having pancreatic ductal adenocarcinoma were screened in the West China Hospital of Sichuan University. The multivariate analysis results were implemented to construct a nomogram. The concordance index (c-index), the area under the curve (AUC) and calibration were utilized to evaluate the predictive performance of the nomogram.

Results: The prognostic nutritional index (PNI), the lymph node ratio (LNR) and the American Joint Committee on Cancer (AJCC) staging served as independent prognostic factors and were used to construct the nomogram. The c-indexes of the nomogram were 0.799 (confidence interval (CI), 0.741-0.858) and 0.732 (0.657-0.807) in the primary set and validation set, respectively. The AUCs of the nomogram at 1 and 3 years were 0.832 and 0.783, which were superior to the AJCC staging values of 0.759 and 0.705, respectively.

Conclusions: The nomogram may be used to predict the prognosis of radical resection for adenocarcinoma of the pancreatic head. These findings may represent an effective model for the developing an optimal therapeutic schedule for malnourished patients who need early effective nutritional intervention and may promote the treatment efficacy of resectable adenocarcinoma of the pancreatic head.

Keywords: Adenocarcinoma of the pancreatic head; Nomogram; Pancreaticoduodenectomy; Prognostic.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The Kaplan–Meier analysis and performance of PNI in predicting 1-and 3-year prognosis respectively in primary set (ab) and validation set (cd)
Fig. 2
Fig. 2
The Kaplan–Meier analysis and the predictive power of LNR in predicting 1-and 3-year prognosis respectively in primary set (ab) and validation set (cd)
Fig. 3
Fig. 3
Nomogram for predicting OS of pancreatic head cancer underwent radical pancreaticoduodenectomy
Fig. 4
Fig. 4
The Calibration curves for the nomogram. Nomogram for predicting 1-, 2-, and 3-year OS respectively in primary set (a) and validation set (b)
Fig. 5
Fig. 5
Comparison of the performance of the nomogram and AJCC stage by AUC at 1 and 3 years in primary set (a) and validation set (b)
Fig. 6
Fig. 6
Decision curve analysis of pancreatic head cancer underwent radical pancreaticoduodenectomy in primary set (a) and validation set (b). The horizontal solid black line assumed no patients would die, and the solid grey line assumed all patients would die

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi: 10.3322/caac.21492.
    1. Kamisawa T, Wood LD, Itoi T, Takaori K. Pancreatic cancer. Lancet. 2016;388(10039):73–85. doi: 10.1016/S0140-6736(16)00141-0.
    1. Strobel O, Neoptolemos J, Jaeger D, Buechler MW. Optimizing the outcomes of pancreatic cancer surgery. Nat Rev Clin Oncol. 2019;16(1):11–26. doi: 10.1038/s41571-018-0112-1.
    1. Elshaer M, Gravante G, Kosmin M, Riaz A, Al-Bahrani A. A systematic review of the prognostic value of lymph node ratio, number of positive nodes and total nodes examined in pancreatic ductal adenocarcinoma. Ann R Coll Surg Engl. 2017;99(2):101–106. doi: 10.1308/rcsann.2016.0340.
    1. Morimoto D, Yamada S, Murotani K, Sonohara F, Takami H, Suenaga M, Hayashi M, Niwa Y, Tashiro M, Hattori N. Prognostic impact of portal system invasion in pancreatic cancer based on image classification. Pancreas. 2018;47(10):1350–1356. doi: 10.1097/MPA.0000000000001186.
    1. Wasif N, Ko CY, Farrell J, Wainberg Z, Hines OJ, Reber H, Tomlinson JS. Impact of tumor grade on prognosis in pancreatic cancer: should we include grade in AJCC staging? Ann Surg Oncol. 2010;17(9):2312–2320. doi: 10.1245/s10434-010-1071-7.
    1. Lee SH, Chung MJ, Kim B, Lee HS, Lee HJ, Heo JY, Kim YJ, Park JY, Bang S, Park SW. The significance of the prognostic nutritional index for all stages of pancreatic cancer. Nutr Cancer. 2017;69(3):512–519. doi: 10.1080/01635581.2016.1250921.
    1. La Torre M, Nigri G, Petrucciani N, Cavallini M, Aurello P, Cosenza G, Balducci G, Ziparo V, Ramacciato G. Prognostic assessment of different lymph node staging methods for pancreatic cancer with R0 resection: pN staging, lymph node ratio, log odds of positive lymph nodes. Pancreatology. 2014;14(4):289–294. doi: 10.1016/j.pan.2014.05.794.
    1. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85(9):1001–1005.
    1. Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 2011;98(2):268–274. doi: 10.1002/bjs.7305.
    1. You MS, Lee SH, Choi YH, Shin B-S, Paik WH, Ryu JK, Kim Y-T, Jang DK, Lee JK, Kwon W. Lymph node ratio as valuable predictor in pancreatic cancer treated with R0 resection and adjuvant treatment. BMC Cancer. 2019;19(1):952. doi: 10.1186/s12885-019-6193-0.
    1. Aoyama T, Yamamoto N, Kamiya M, Murakawa M, Tamagawa H, Sawazaki S, Numata M, Shiozawa M, Kobayashi S, Ueno M. The lymph node ratio is an independent prognostic factor in pancreatic cancer patients who receive curative resection followed by adjuvant chemotherapy. Anticancer Res. 2018;38(8):4877–4882. doi: 10.21873/anticanres.12801.
    1. Robinson S, Rahman A, Haugk B, French J, Manas D, Jaques B, Charnley R, White S. Metastatic lymph node ratio as an important prognostic factor in pancreatic ductal adenocarcinoma. EJSO. 2012;38(4):333–339. doi: 10.1016/j.ejso.2011.12.020.
    1. Murakami Y, Uemura K, Sudo T, Hayashidani Y, Hashimoto Y, Nakashima A, Yuasa Y, Kondo N, Ohge H, Sueda T. Number of metastatic lymph nodes, but not lymph node ratio, is an independent prognostic factor after resection of pancreatic carcinoma. J Am Coll Surg. 2010;211(2):196–204. doi: 10.1016/j.jamcollsurg.2010.03.037.
    1. Yamamoto Y, Ikoma H, Morimura R, Konishi H, Murayama Y, Komatsu S, Shiozaki A, Kuriu Y, Kubota T, Nakanishi M. The clinical impact of the lymph node ratio as a prognostic factor after resection of pancreatic cancer. Anticancer Res. 2014;34(5):2389–2394.
    1. Liu Z-Q, Xiao Z-W, Luo G-P, Liu L, Liu C, Xu J, Long J, Ni Q-X, Yu X-J. Effect of the number of positive lymph nodes and lymph node ratio on prognosis of patients after resection of pancreatic adenocarcinoma. Hepatobiliary Pancreat Dis Int. 2014;13(6):634–641. doi: 10.1016/S1499-3872(14)60264-2.
    1. Schiesser M, Kirchhoff P, Müller MK, Schäfer M, Clavien P-A. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery. 2009;145(5):519–526. doi: 10.1016/j.surg.2009.02.001.
    1. Altman AM, Wirth K, Marmor S, Lou E, Chang K, Hui JY, Tuttle TM, Jensen EH, Denbo JW. Completion of adjuvant chemotherapy after upfront surgical resection for pancreatic cancer is uncommon yet associated with improved survival. Ann Surg Oncol. 2019;26(12):4108–4116. doi: 10.1245/s10434-019-07602-6.
    1. White RJ, Hasan S, Monga D, Finley G, Islam M, Schiffman S, Williams HK, Kulkarni A, Thakkar S, Kirichenko AV. Time to adjuvant systemic therapy following pancreatic cancer resection and effect on outcome. Pancreas. 2019;48(8):1086–1091. doi: 10.1097/MPA.0000000000001373.
    1. Wang H, Liu J, Xia G, Lei S, Huang X, Huang X. Survival of pancreatic cancer patients is negatively correlated with age at diagnosis: a population-based retrospective study. Sci Rep. 2020;10(1):1–9. doi: 10.1038/s41598-019-56847-4.
    1. Bagni K, Chen IM, Johansen AZ, Dehlendorff C, Jensen BV, Hansen CP, Preus Hasselby J, Holländer NH, Nissen M, Bjerregaard JK. Prognostic impact of Charlson’s age-comorbidity index and other risk factors in patients with pancreatic cancer. Eur J Cancer Care. 2020;29(3):e13219. doi: 10.1111/ecc.13219.
    1. Iwai N, Okuda T, Sakagami J, Harada T, Ohara T, Taniguchi M, Sakai H, Oka K, Hara T, Tsuji T. Neutrophil to lymphocyte ratio predicts prognosis in unresectable pancreatic cancer. Sci Rep. 2020;10(1):1–7. doi: 10.1038/s41598-019-56847-4.
    1. Brennan MF, Kattan MW, Klimstra D, Conlon K. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg. 2004;240(2):293–298. doi: 10.1097/01.sla.0000133125.85489.07.
    1. Bian Y, Guo S, Jiang H, Gao S, Shao C, Cao K, Fang X, Li J, Wang L, Hua W. Relationship between radiomics and risk of lymph node metastasis in pancreatic ductal adenocarcinoma. Pancreas. 2019;48(9):1195–1203. doi: 10.1097/MPA.0000000000001404.
    1. Suzuki Y, Takadate T, Mizuma M, Shima H, Suzuki T, Tachibana T, Shimura M, Hata T, Iseki M, Kawaguchi K. Stromal expression of hemopexin is associated with lymph-node metastasis in pancreatic ductal adenocarcinoma. PLoS One. 2020;15(7):e0235904. doi: 10.1371/journal.pone.0235904.
    1. Collard M, Voron T, Svrcek M, Ahmed O, Balladur P, Hor T, André T, Paye F. Para-aortic lymph node metastasis detected intraoperatively by systematic frozen section examination in pancreatic head adenocarcinoma: is resection improving the prognosis? HPB. 2020;22(11):1604–1612. doi: 10.1016/j.hpb.2020.02.009.
    1. Pinato D, North B, Sharma R. A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI) Br J Cancer. 2012;106(8):1439–1445. doi: 10.1038/bjc.2012.92.
    1. Chan AW, Chan SL, Wong GL, Wong VW, Chong CC, Lai PB, Chan HL, To K-F Prognostic nutritional index (PNI) predicts tumor recurrence of very early/early stage hepatocellular carcinoma after surgical resection. Ann Surg Oncol. 2015;22(13):4138–4148. doi: 10.1245/s10434-015-4516-1.
    1. Hong S, Zhou T, Fang W, Xue C, Hu Z, Qin T, Tang Y, Chen Y, Ma Y, Yang Y. The prognostic nutritional index (PNI) predicts overall survival of small-cell lung cancer patients. Tumor Biol. 2015;36(5):3389–3397. doi: 10.1007/s13277-014-2973-y.
    1. Jin S, Cao S, Xu S, Wang C, Meng Q, Yu Y. Clinical impact of pretreatment prognostic nutritional index (PNI) in small cell lung cancer patients treated with platinum-based chemotherapy. Clin Respir J. 2018;12(9):2433–2440. doi: 10.1111/crj.12925.
    1. Yang L, Xia L, Wang Y, Hong S, Chen H, Liang S, Peng P, Chen Y. Low prognostic nutritional index (PNI) predicts unfavorable distant metastasis-free survival in nasopharyngeal carcinoma: a propensity score-matched analysis. PLoS One. 2016;11(7):e0158853. doi: 10.1371/journal.pone.0158853.
    1. Migita K, Takayama T, Saeki K, Matsumoto S, Wakatsuki K, Enomoto K, Tanaka T, Ito M, Kurumatani N, Nakajima Y. The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage. Ann Surg Oncol. 2013;20(8):2647–2654. doi: 10.1245/s10434-013-2926-5.
    1. Xu J, Zhong Y, Jing D, Wu Z. Preoperative enteral immunonutrition improves postoperative outcome in patients with gastrointestinal cancer. World J Surg. 2006;30(7):1284–1289. doi: 10.1007/s00268-005-0756-8.
    1. Fukuda T, Seto Y, Yamada K, Hiki N, Fukunaga T, Oyama S, Yamaguchi T. Can immune-enhancing nutrients reduce postoperative complications in patients undergoing esophageal surgery? Dis Esophagus. 2008;21(8):708–711. doi: 10.1111/j.1442-2050.2008.00861.x.
    1. Zaloga GP. Parenteral nutrition in adult inpatients with functioning gastrointestinal tracts: assessment of outcomes. Lancet. 2006;367(9516):1101–1111. doi: 10.1016/S0140-6736(06)68307-4.

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