Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2023; 15(1): 128-142
Published online Jan 15, 2023. doi: 10.4251/wjgo.v15.i1.128
Risk factors, prognostic predictors, and nomograms for pancreatic cancer patients with initially diagnosed synchronous liver metastasis
Bi-Yang Cao, Fang Tong, Le-Tian Zhang, Yi-Xin Kang, Chen-Chen Wu, Qian-Qian Wang, Wei Yang, Jing Wang
Bi-Yang Cao, Fang Tong, Le-Tian Zhang, Yi-Xin Kang, Chen-Chen Wu, Qian-Qian Wang, Wei Yang, Jing Wang, Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Bi-Yang Cao, Le-Tian Zhang, Yi-Xin Kang, Chen-Chen Wu, Medical School of Chinese PLA, Beijing 100853, China
Author contributions: Cao BY and Tong F contributed equally to this work; Cao BY and Tong F designed the research and wrote the first manuscript; Zhang LT, Kang YX, Wu CC, and Wang QQ contributed to conceiving the research and analyzing the data; Yang W and Wang J conducted the analysis and provided guidance for the research, and they were co-corresponding authors, and all authors reviewed and approved the final manuscript.
Institutional review board statement: Our research is based on the National Cancer Institute’s SEER program. For this study, we signed the SEER research data agreement to access SEER information, using reference number 15159-Nov2020. Data were obtained following the approved guidelines. The Office for Human Research Protection considered this research to be on nonhuman subjects because the subjects were patients who had been researched by the United States Department of Health and Human Services and were publicly accessible and de-dentified. Thus, no institutional review board approval was required.
Informed consent statement: Patients were not required to provide 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 report no relevant conflicts of interest for this article.
Data sharing statement: The dataset from SEER database analyzed during the current study are available in the SEER dataset repository (https://seer.cancer.gov/).
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Yang, PhD, Professor, Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. yangwei1437@163.com
Received: November 2, 2022
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
ARTICLE HIGHLIGHTS
Research background

Pancreatic cancer (PC) with liver metastasis (LM) is a commonly fatal disease with an extremely poor prognosis. Identifying the risk and prognostic factors of PC patients with LM (PCLM) is essential and may aid in providing timely medical interventions to improve the prognosis of these patients.

Research motivation

Few studies have focused on investigating PCLM patients’ risk and prognostic factors, and there are no corresponding diagnostic and prognostic nomograms for these entities.

Research objectives

This study aimed to investigate the risk and prognostic factors of PCLM and establish corresponding diagnostic and prognostic nomograms.

Research methods

Patients from the Surveillance, Epidemiology, and End Results database with primary PC diagnosed between 2010 and 2015 were reviewed. A multivariate logistic regression analysis was used to identify risk factors to develop a diagnostic model. The least absolute shrinkage and selection operator Cox regression model was used to determine the prognostic factors used to establish a 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. Survival analysis was performed using the Kaplan-Meier method with a log-rank test.

Research results

A total of 33459 PC patients were included in the study, with 11458 patients (34.2%) having 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. The independent factors associated with poor prognosis for patients with PCLM include age > 70 years, adenocarcinoma, poor or anaplastic differentiation, lung metastasis, no surgery, and no chemotherapy. The C-indices of the diagnostic and prognostic nomograms were 0.731 and 0.753, respectively. Based on the observed analysis results of ROC curves, calibration plots, and DCA curves, the two nomograms could accurately predict the occurrence and prognosis of patients with PCLM. The prognostic nomogram could stratify patients into prognostic groups and perform well in terms of internal validation.

Research conclusions

Our study identified the risk and prognostic factors in patients with PCLM and constructed corresponding diagnostic and prognostic nomograms to guide subsequent clinical evaluation and intervention for clinicians.

Research perspectives

The nomograms constructed in this study can help clinicians provide better prevention for high-risk subjects and monitor their prognosis. External validation is required to verify these results.