scholarly journals Effects of Total Pancreatectomy on Survival of Patients With Pancreatic Ductal Adenocarcinoma: A Population-Based Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Weiwei Shao ◽  
Zhenhua Lu ◽  
Jingyong Xu ◽  
Xiaolei Shi ◽  
Tianhua Tan ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Cox Regression ◽  
Total Pancreatectomy ◽  
Staging System ◽  
Prognostic Indicators ◽  
Ductal Adenocarcinoma ◽  
Rank Test ◽  
Term Survival ◽  
Ajcc Staging System ◽  
Ajcc Staging

Background: Total pancreatectomy (TP) seems to be experiencing a renaissance in recent years. In this study, we aimed to determine the long-term survival of pancreatic ductal adenocarcinoma (PDAC) patients who underwent TP by comparing with pancreaticoduodenectomy (PD), and formulate a nomogram to predict overall survival (OS) for PDAC individuals following TP.Methods: Patients who were diagnosed with PDAC and received PD (n = 5,619) or TP (n = 1,248) between 2004 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. OS and cancer-specific survival (CSS) of the PD and TP groups were compared using Kaplan-Meier method and log-rank test. Furthermore, Patients receiving TP were randomly divided into the training and validation cohorts. Univariate and multivariate Cox regression were applied to identify the independent factors affecting OS to construct the nomogram. The performance of the nomogram was measured according to concordance index (C-index), calibration plots, and decision curve analysis (DCA).Results: There were no significant differences in OS and CSS between TP and PD groups. Age, differentiation, AJCC T stage, radiotherapy, chemotherapy, and lymph node ratio (LNR) were identified as independent prognostic indicators to construct the nomogram. The C-indexes were 0.67 and 0.69 in the training and validation cohorts, while 0.59 and 0.60 of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system. The calibration curves showed good uniformity between the nomogram prediction and actual observation. DCA curves indicated the nomogram was preferable to the AJCC staging system in terms of the clinical utility. A new risk stratification system was constructed which could distinguish patients with different survival risks.Conclusions: For PDAC patients following TP, the OS and CSS are similar to those who following PD. We developed a practical nomogram to predict the prognosis of PDAC patients treated with TP, which showed superiority over the conventional AJCC staging system.

scholarly journals Development and validation of a Nomogram for predicting the Overall Survival of Patients With Pancreatic Ductal Adenocarcinoma of the Head of the Pancreas

2021 ◽  
Author(s):  
Zhilong Liu ◽  
Haohui Yu ◽  
Mingrong Cao ◽  
Jiexing Li ◽  
Yulin Huang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Staging System ◽  
The United States ◽  
Ductal Adenocarcinoma ◽  
Seer Database ◽  
Training Set ◽  
Head Of The Pancreas ◽  
Ajcc Staging System ◽  
Ajcc Staging

Abstract Background: The purpose of this study is to develop and validate a nomogram to predict the overall survival (OS) of patients with Pancreatic Ductal Adenocarcinoma of the Head of the Pancreas (PDAC-HP).Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we collected patients with PDAC-HP in the United States between 2004 and 2015. Patients were randomly divided into training set and validating set at a ratio of 7:3. The training set is used to develop a nomogram for predicting OS. These indicators such as the C index, the area under curve (AUC) of the receiver operating characteristic (ROC), calibration plots and the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) were used to evaluate the prediction accuracy of the nomogram.Results: A total of 33,893 patients with PDAC-HP over 20 years old were diagnosed between 2004 and 2015 were collected from the SEER database. Using multivariable Cox regression analysis, we identified eight risk factors that were associated with OS, such as age at diagnosis, sex, marital status at diagnosis, race, AJCC staging, surgery, radiotherapy and chemotherapy. A nomogram was constructed based on these variables. Compared with the AJCC staging system, the nomogram has a better C index and AUC in the training set and validatiing set. The calibration plots indicated that the nomogram was able to accurately predict the OS of patients with PDAC-HP at 1, 3, and 5 years.Conclusions: We developed and validated a nomogram, and predicted the OS of patients with PDAC-HP at 1, 3, and 5 years. Compared with the AJCC staging system, the nomogram we constructed has better performance. It shows that our nomogram could be served as an effective tool for prognostic evaluation of patients with PDAC-HP.

Proposed Modification of the 8th Edition of the AJCC Staging System for Pancreatic Ductal Adenocarcinoma

2019 ◽  
Vol 269 (5) ◽  
pp. 944-950 ◽  
Author(s):  
Si Shi ◽  
Jie Hua ◽  
Chen Liang ◽  
Qingcai Meng ◽  
Dingkong Liang ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Staging System ◽  
Ductal Adenocarcinoma ◽  
Ajcc Staging System ◽  
Proposed Modification ◽  
Ajcc Staging ◽  
8Th Edition

scholarly journals Liver Metastases in Newly Diagnosed Pancreatic Ductal Adenocarcinoma: A Population Based Analysis

2020 ◽  
Author(s):  
Guoyi Wu ◽  
Xiaoben Pan ◽  
Baohua Wang ◽  
Xiaolei Zhu ◽  
Jing Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Metastases ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Tumor Size ◽  
Cox Regression ◽  
Population Based ◽  
The Body ◽  
Ductal Adenocarcinoma ◽  
Rank Test ◽  
Factors Associated

Abstract Background Estimates of the incidence and prognosis of developing liver metastases at the pancreatic ductal adenocarcinoma (PDAC) diagnosis are lacking.Methods In this study, we analyzed the association of liver metastases and the PDAC patients outcome. The risk factors associated with liver metastases in PDAC patients were analyzed using multivariable logistic regression analysis. The overall survival (OS) was estimated using Kaplan-Meier curves and log-rank test. Cox regression was performed to identify factors associated with OS.Results Patients with primary PDAC in the tail of the pancreas had a higher incidence of liver metastases (62.2%) than those with PDAC in the head (28.6%). Female gender, younger age, primary PDAC in the body or tail of the pancreas, and larger primary PDAC tumor size were positively associated with the occurrence of liver metastases. The median survival of patients with liver metastases was significantly shorter than that of patients without liver metastases. Older age, unmarried status, primary PDAC in the tail of the pancreas, and tumor size ≥4 cm were risk factors for OS in the liver metastases cohort.Conclusions Population-based estimates of the incidence and prognosis of PDAC with liver metastases may help decide whether diffusion-weighted magnetic resonance imaging should be performed in patients with primary PDAC in the tail or body of the pancreas. The location of primary PDAC should be considered during the diagnosis and treatment of primary PDAC.

Seventh edition (2010) of gastric adenocarcinoma AJCC staging system: Is there room for improvement?

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 77-77
Author(s):  
Manali I. Patel ◽  
Kim F Rhoads ◽  
Yifei Ma ◽  
James M. Ford ◽  
Jeffrey A. Norton ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastric Adenocarcinoma ◽  
Health Planning ◽  
Gastroesophageal Junction ◽  
Staging System ◽  
Rank Test ◽  
Population Database ◽  
Curative Intent ◽  
Ajcc Staging System ◽  
Ajcc Staging

77 Background: The gastric cancer AJCC staging system recently underwent significant modifications of the T and N categories as well as stage groupings. The new system has not been validated on a US population database, but studies on Asian patients have reported no difference in survival between stages IB and IIA, as well as IIB and IIIA. Methods: California Cancer Registry data linked to Office of Statewide Health Planning and Development discharge abstracts were used to identify patients with gastric adenocarcinoma (gastroesophageal junction tumors excluded) who underwent curative-intent surgical resection from 2002 to 2006. AJCC stage was reclassified based on the 7th edition. Disease-specific survival (DSS) probabilities were calculated using the Kaplan-Meier method and compared using the log rank test. Results: Of 4,985 patients identified, 2,262 had complete pathologic data and known cause of death. Median age was 70 years and 60% were males. Median number of examined lymph nodes was 12 and 39% of patients received adjuvant chemotherapy. The 7th edition AJCC system did not distinguish outcome adequately between stages IB and IIA (P = .25), or IIB and IIIA (P = .33, Table ). By merging stage II into one category and moving T2N1 to stage IB and T2N2, T1N3 to stage IIIA, we propose a new grouping system which showed improved discriminatory ability ( Table ). Conclusions: In this first study validating the new 7th edition AJCC staging system for gastric cancer on a US population, we found stages IB and IIA, as well as IIB and IIIA to perform similarly. We propose a revised stage grouping for the AJCC system that better discriminates between outcomes. [Table: see text]

Changes in the 2003 American Joint Committee on Cancer Staging for Breast Cancer Dramatically Affect Stage-Specific Survival

2003 ◽  
Vol 21 (17) ◽  
pp. 3244-3248 ◽  
Author(s):  
Wendy A. Woodward ◽  
Eric A. Strom ◽  
Susan L. Tucker ◽  
Marsha D. McNeese ◽  
George H. Perkins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Strategies ◽  
Staging System ◽  
Stage Ii ◽  
Rank Test ◽  
Breast Cancer Patients ◽  
American Joint Committee ◽  
Number Of Patients ◽  
Ajcc Staging System ◽  
Ajcc Staging

Purpose: To evaluate how implementation of the 2003 American Joint Committee on Cancer (AJCC) staging system will affect stage-specific survival of breast cancer patients. Patients and Methods: Records of 1,350 patients treated on sequential institutional protocols with mastectomy and adjuvant doxorubicin-based chemotherapy were reviewed. Pathologic stage was assigned retrospectively according to the 1988 and the 2003 AJCC staging criteria. Overall stage-specific survival (OS) was calculated using the Kaplan-Meier method, and hypothetical differences were compared by the log-rank test. Results: Six hundred five of 1,087 patients with stage II disease according to the 1988 classification system had stage II disease according to the 2003 system. The 10-year OS for patients with stage II disease was significantly improved using the 2003 system (76% [2003] v 65% [1988]; P < .0001). Two hundred eighty-nine of 633 patients with stage IIb disease using the 1988 system were stage IIb with the 2003 system, and 10-year OS was 58% (1988) versus 70% (2003; P = .003). The number of patients with stage III disease increased from 207 (1988) to 443 (2003), and the 10-year OS changed from 45% (1988) to 50% (2003; P = .077). Most of this difference resulted from changes within stage IIIa: OS, 45% (1988) versus 59% (2003; P < .0001). Conclusion: Stage reclassification using the new AJCC staging system for breast cancer will result in significant changes in reported outcome by stage. It is imperative that careful attention is devoted to this effect so that accurate conclusions regarding the efficacy of new treatment strategies can be drawn.

scholarly journals Combining Gene Expression Signature With Clinical Features for Survival Stratification of Gastric Cancer

2020 ◽  
Author(s):  
Qiang Sun ◽  
Dongyang Guo ◽  
Shuang Li ◽  
Yanjun Xu ◽  
Mingchun Jiang ◽  
...  
Keyword(s):  
Gene Expression ◽  
Gastric Cancer ◽  
Clinical Practice ◽  
Risk Score ◽  
Genetic Risk ◽  
Cox Regression ◽  
Genetic Risk Score ◽  
Staging System ◽  
Ajcc Staging System ◽  
Ajcc Staging

Abstract Background: The AJCC staging system is considered as the golden standard in clinical practice. However, it remains some pitfalls in assessing the prognosis of gastric cancer (GC) patients with similar clinicopathological characteristics. We aim to develop a new clinic and genetic risk score (CGRS) to improve the prognosis prediction of GC patients.Methods: The gene expression profiles of the training set from the Asian Cancer Research Group (ACRG) cohort were used for developing genetic risk score (GRS) by LASSO-Cox regression algorithms. CGRS was established by integrating GRS with clinical risk score (CRS) derived from Surveillance, Epidemiology, and End Results (SEER) database. GRS and CGRS were validated in ACRG validation set and other four independent GC cohorts with different data types, such as microarray, RNA sequencing, and qRT-PCR. Multivariable Cox regression was adopted to evaluate the independence of GRS and CGRS in prognosis evaluation.Results: We established GRS based on a nine-gene signature including APOD, CCDC92, CYS1, GSDME, ST8SIA5, STARD3NL, TIMEM245, TSPYL5, and VAT1. GRS and CGRS dichotomized GC patients into high and low risk groups with significantly different prognosis in four independent cohorts, including our Zhejiang cohort (all HR > 1, all P < 0.001). Both GRS and CGRS were prognostic signatures independent of the AJCC staging system. Receiver operating characteristic (ROC) analysis showed that area under ROC curve of CGRS was larger than that of the AJCC staging system in most cohorts we studied. Nomogram and web tool (http://39.100.117.92/CGRS/) based on CGRS were developed for clinicians to conveniently assess GC prognosis in clinical practice.Conclusions: CGRS integrating genetic signature with clinical features shows strong robustness in predicting GC prognosis, and can be easily applied in clinical practice through the web application.

scholarly journals A Novel Nomogram for Predicting Cancer-Specific Survival in Women with Uterine Sarcoma: A Large Population-Based Study

2021 ◽  
Author(s):  
Yuan-jie Li ◽  
Jun Lyu ◽  
Chen Li ◽  
Hai-rong He ◽  
Jin-feng Wang ◽  
...  
Keyword(s):  
Cox Regression ◽  
Validation Cohort ◽  
Large Population ◽  
Staging System ◽  
Uterine Sarcoma ◽  
Operating Characteristics ◽  
Cancer Specific Survival ◽  
Cox Regression Analysis ◽  
Ajcc Staging System ◽  
Ajcc Staging

Abstract Background: To develop a comprehensive nomogram for predicting the cancer-specific survival (CSS) for uterine sarcoma (US).Methods: 3861 patients of US between 2010 to 2015 were identified for this study from the Surveillance, Epidemiology, and End Results (SEER) database. They were randomly divided into a training cohort (n = 2702) and a validation cohort (n = 1159) in a 7-to-3 ratio by R software. Multivariate Cox regression analysis was performed to select predictive variables and then to identify independent prognostic factors. The concordance index (C-index), the area under the time-dependent receiver operating characteristics curve (AUC), the net reclassification improvement (NRI), the integrated discrimination improvement (IDI), calibration plotting, and decision-curve analysis (DCA) were used to compare the new survival nomogram with the AJCC 7th edition prognosis model.Results: We have established a nomogram for determining the 1-, 3-, and 5-year CSS probabilities of US patients. In this nomogram, pathology grade has the highest risk on CSS in US, followed by the age at diagnosis, then surgery status. The C-index for the nomogram (0.796, 0.767 for the training and validation cohort, respectively) was higher than those for the AJCC staging system (0.706 and 0.713, respectively). Furthermore, AUC value, NRI, IDI, calibration plotting, and DCA showed that this nomogram exhibited better performance than the AJCC staging system alone.Conclusion: Our study validated the first comprehensive nomogram for US which could provide more accurately and individualized survival predictions for US patients in clinical practice.

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