Moekotte AL, van Roessel S, Malleo G, Rajak R, Ecker BL, Fontana M, Han HS, Rabie M, Roberts KJ, Khalil K, White SA, Robinson S, Halimi A, Zarantonello L, Fusai GK, Gradinariu G, Alseidi A, Bonds M, Dreyer S, Jamieson NB, Mowbray N, Al-Sarireh B, Mavroeidis VK, Soonawalla Z, Napoli N, Boggi U, Kent TS, Fisher WE, Tang CN, Bolm L, House MG, Dillhoff ME, Behrman SW, Nakamura M, Ball CG, Berger AC, Christein JD, Zureikat AH, Salem RR, Vollmer CM, Salvia R, Besselink MG, Abu Hilal M, Aljarrah R, Barrows C, Cagigas MN, Lai ECH, Wellner U, Aversa J, Dickson PV, Ohtsuka T, Dixon E, Zheng R, Kowalski S, Freedman-Weiss M. Development and external validation of a prediction model for survival in patients with resected ampullary adenocarcinoma.
EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020;
46:1717-1726. [PMID:
32624291 DOI:
10.1016/j.ejso.2020.04.011]
[Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/26/2020] [Accepted: 04/09/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION
Ampullary adenocarcinoma (AAC) is a rare malignancy with great morphological heterogeneity, which complicates the prediction of survival and, therefore, clinical decision-making. The aim of this study was to develop and externally validate a prediction model for survival after resection of AAC.
MATERIALS AND METHODS
An international multicenter cohort study was conducted, including patients who underwent pancreatoduodenectomy for AAC (2006-2017) from 27 centers in 10 countries spanning three continents. A derivation and validation cohort were separately collected. Predictors were selected from the derivation cohort using a LASSO Cox proportional hazards model. A nomogram was created based on shrunk coefficients. Model performance was assessed in the derivation cohort and subsequently in the validation cohort, by calibration plots and Uno's C-statistic. Four risk groups were created based on quartiles of the nomogram score.
RESULTS
Overall, 1007 patients were available for development of the model. Predictors in the final Cox model included age, resection margin, tumor differentiation, pathological T stage and N stage (8th AJCC edition). Internal cross-validation demonstrated a C-statistic of 0.75 (95% CI 0.73-0.77). External validation in a cohort of 462 patients demonstrated a C-statistic of 0.77 (95% CI 0.73-0.81). A nomogram for the prediction of 3- and 5-year survival was created. The four risk groups showed significantly different 5-year survival rates (81%, 57%, 22% and 14%, p < 0.001). Only in the very-high risk group was adjuvant chemotherapy associated with an improved overall survival.
CONCLUSION
A prediction model for survival after curative resection of AAC was developed and externally validated. The model is easily available online via www.pancreascalculator.com.
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