Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2020; 26(5): 535-549
Published online Feb 7, 2020. doi: 10.3748/wjg.v26.i5.535
Nomograms predicting long-term survival in patients with invasive intraductal papillary mucinous neoplasms of the pancreas: A population-based study
Jia-Yuan Wu, Yu-Feng Wang, Huan Ma, Sha-Sha Li, Hui-Lai Miao
Jia-Yuan Wu, Hui-Lai Miao, Department of Clinical Research, the Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
Yu-Feng Wang, Huan Ma, Sha-Sha Li, School of Public Health, Guangdong Medical University, Zhanjiang 524023, Guangdong Province, China
Hui-Lai Miao, Department of Hepatobiliary Surgery, the Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
Hui-Lai Miao, Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524003, Guangdong Province, China
Author contributions: Wu JY and Wang YF contributed equally to this work. All authors helped to performed the research; Wu JY contributed to manuscript writing, data extraction, and data analysis; Wang YF contributed to manuscript writing, drafting, conception and design; Ma H contributed to manuscript writing, data collection, and statistical analysis; Li SS contributed to manuscript writing, statistical software, and data analysis; Miao HL contributed to study design, manuscript writing, drafting, conception and design.
Supported by National Natural Science Foundation of China, No. 81702270; the Natural Science Foundation of Guangdong, No. 2015A030313827; The Affiliated Hospital of Guangdong Medical University Clinical Research Program, No. LCYJ2018C012.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Affiliated Hospital of Guangdong Medical University.
Informed consent statement: Patients were not required to give informed consent to the study because this study used a public database with anonymous clinical data and the patients’ personal privacy information was not available.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: The relevant data in this study can be obtained in the SEER database.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hui-Lai Miao, MD, Professor, Department of Clinical Research, the Affiliated Hospital of Guangdong Medical University, No. 57 South of Renmin Avenue, Zhanjiang 524001, Guangdong Province, China. 627225370@qq.com
Received: November 7, 2019
Peer-review started: November 7, 2019
First decision: December 7, 2019
Revised: January 6, 2020
Accepted: January 11, 2020
Article in press: January 11, 2020
Published online: February 7, 2020
Abstract
BACKGROUND

There are few effective tools to predict survival in patients with invasive intraductal papillary mucinous neoplasms of the pancreas.

AIM

To develop comprehensive nomograms to individually estimate the survival outcome of patients with invasive intraductal papillary mucinous neoplasms of the pancreas.

METHODS

Data of 1219 patients with invasive intraductal papillary mucinous neoplasms after resection were extracted from the Surveillance, Epidemiology, and End Results database, and randomly divided into the training (n = 853) and the validation (n = 366) cohorts. Based on the Cox regression model, nomograms were constructed to predict overall survival and cancer-specific survival for an individual patient. The performance of the nomograms was measured according to discrimination, calibration, and clinical utility. Moreover, we compared the predictive accuracy of the nomograms with that of the traditional staging system.

RESULTS

In the training cohort, age, marital status, histological type, T stage, N stage, M stage, and chemotherapy were selected to construct nomograms. Compared with the American Joint Committee on Cancer 7th staging system, the nomograms were generally more discriminative. The nomograms passed the calibration steps by showing high consistency between actual probability and nomogram prediction. Categorial net classification improvements and integrated discrimination improvements suggested that the predictive accuracy of the nomograms exceeded that of the American Joint Committee on Cancer staging system. With respect to decision curve analyses, the nomograms exhibited more preferable net benefit gains than the staging system across a wide range of threshold probabilities.

CONCLUSION

The nomograms show improved predictive accuracy, discrimination capability, and clinical utility, which can be used as reliable tools for risk classification and treatment recommendations.

Keywords: Invasive intraductal papillary mucinous neoplasm, Pancreas, Nomogram, Overall survival, Cancer-specific survival, Surgical resection

Core tip: Due to its rarity, it is difficult to develop a prognostic nomogram for intraductal papillary mucinous neoplasms (IPMNs) of the pancreas in a single institution; however, the Surveillance, Epidemiology, and End Results database has provided useful data on prognosis. To date, no study has focused on a predictive model for the prognosis of IPMNs. In this study, we developed nomograms to predict the probability of overall survival and cancer-specific survival at different time points in patients with invasive IPMNs of the pancreas based on the Surveillance, Epidemiology, and End Results dataset. Compared with the American Joint Committee on Cancer 7th staging system, the formulated nomograms in this study showed perfect performance in terms of discrimination, calibration, reclassification, and clinical usefulness.