Published online Jan 15, 2023. doi: 10.4251/wjgo.v15.i1.128
Peer-review started: November 2, 2022
First decision: November 14, 2022
Revised: November 17, 2022
Accepted: December 7, 2022
Article in press: December 7, 2022
Published online: January 15, 2023
Processing time: 69 Days and 4.5 Hours
Liver metastasis (LM) remains a major cause of cancer-related death in patients with pancreatic cancer (PC) and is associated with a poor prognosis. Therefore, identifying the risk and prognostic factors in PC patients with LM (PCLM) is essential as it may aid in providing timely medical interventions to improve the prognosis of these patients. However, there are limited data on risk and prognostic factors in PCLM patients.
To investigate the risk and prognostic factors of PCLM and develop corresponding diagnostic and prognostic nomograms.
Patients with primary PC diagnosed between 2010 and 2015 were reviewed from the Surveillance, Epidemiology, and Results Database. Risk factors were identified using multivariate logistic regression analysis to develop the diagnostic mode. The least absolute shrinkage and selection operator Cox regression model was used to determine the prognostic factors needed to develop the prognostic model. The performance of the two nomogram models was evaluated using receiver operating characteristic (ROC) curves, calibration plots, decision curve analysis (DCA), and risk subgroup classification. The Kaplan-Meier method with a log-rank test was used for survival analysis.
We enrolled 33459 patients with PC in this study. Of them, 11458 (34.2%) patients had LM at initial diagnosis. Age at diagnosis, primary site, lymph node metastasis, pathological type, tumor size, and pathological grade were identified as independent risk factors for LM in patients with PC. Age > 70 years, adenocarcinoma, poor or anaplastic differentiation, lung metastases, no surgery, and no chemotherapy were the independently associated risk factors for poor prognosis in patients with PCLM. The C- index of diagnostic and prognostic nomograms were 0.731 and 0.753, respectively. The two nomograms could accurately predict the occurrence and prognosis of patients with PCLM based on the observed analysis results of ROC curves, calibration plots, and DCA curves. The prognostic nomogram could stratify patients into prognostic groups and perform well in internal validation.
Our study identified the risk and prognostic factors in patients with PCLM and developed corresponding diagnostic and prognostic nomograms to help clinicians in subsequent clinical evaluation and intervention. External validation is required to confirm these results.
Core Tip: Pancreatic cancer (PC) has a poor prognosis owing to its risk of metastasis. The risk and prognostic factors for patients with distant metastasis at diagnosis have been studied; however, few studies have focused on liver metastasis (LM), the most common target organ. This study investigated the risk and prognostic factors for PC patients with LM at diagnosis using the Surveillance, Epidemiology, and End Results database on a population-based level and developed two nomograms for predicting the risk and prognosis for these patients. The nomograms developed in this study can be a convenient tool for facilitating clinical decision-making.