Development and validation of a nomogram for predicting survival in patients with pancreatic ductal adenocarcinoma after radical pancreatoduodenectomy

Abstract

Abstract Objectives Hypercoagulation and malnutrition are the characteristic pathophysiological changes associated with pancreatic ductal adenocarcinoma (PDAC), which are intimately related to cancer progression and prognosis. We aimed to integrate related indicators to build a nomogram model to predict the overall survival (OS) of PDAC patients underwent radical pancreatoduodenectomy (PD). Methods Clinicopathological and survival data of 138 patients were retrospectively analyzed according to inclusion and exclusion criteria. A nomogram was built based on the multivariate Cox regression analysis. The receiver operating characteristic curve (ROC) and calibration curves were performed based on the bootstrap method to evaluate the predictive performance of the nomogram. Decision curve analysis (DCA) was performed to assess the clinical usefulness of the nomogram. Results High-grade tumor (Hazard ratio [HR]: 3.70; 95% confidence interval [CI]: 1.51–3.82; p<0.001), vessel carcinoma embolus (HR: 2.69; 95% CI: 1.30–5.31, p=0.007), N2 (HR: 2.90; 95% CI: 1.47–7.37; p=0.004), anemia (HR: 1.98; 95% CI: 1.01–2.70; p=0.047), PLR>244.8 (HR: 2.13; 95% CI: 1.05–3.45; p=0.033), FBG>3.50 g/L (HR: 2.10; 95% CI: 1.04–3.09, p=0.008), and DRR>1.1 (HR: 2.69; 95% CI: 1.56–4.27; p<0.001) served as independent risk factors for poor OS of patients with PDAC underwent radical PD and were implemented to construct a nomogram. The area under curve (AUCs) for the first, second, and third years were 0.713, 0.777, and 0.845, respectively. Besides, calibration curves fitted well to the ideal line. DCA shows that the nomogram has greater net benefit than the existing TNM staging system, suggesting that this model is a more practical clinical tool for predicting the prognosis of PDAC patients. Conclusions The nomogram we established based on the characteristic pathophysiological alterations of PDAC for predicting OS in patients who underwent radical pancreatoduodenectomy presented considerable predictive power. It may facilitate prognostic risk stratification and optimize therapeutic decision-making.