Development and validation of a novel nutrition-based nomogram to predict prognosis in pancreatic cancer patients receiving first-line systemic chemotherapy from three centres.

Abstract

Abstract Background According to clinical trials, the median survival time of patients with advanced pancreatic cancer does not exceed 1 year. There are great differences in prognosis between different patients with pancreatic cancer, and their nutritional status may play a role. In our study, we sought to explore the predictive value of body composition and weight alteration during chemotherapy. Methods In this retrospective study, 90 patients from 3 hospitals with metastatic or locally advanced unresectable pancreatic cancer treated with chemotherapy were analysed. The changes in weight and skeletal muscle index (SMI) and other clinical characteristics were evaluated with LASSO Cox regression and multivariate Cox regression analysis, which were applied to construct nomograms. The performance of the nomograms was validated internally by using the bootstrap method with 100 resample models and was assessed by the concordance index (C-index), calibration plots, and decision curve analysis (DCA). Results The median progression-free survival (PFS) and overall survival (OS) were 5.9 months and 11.8 months, respectively. Liver metastases, local therapy, operation, L3SMI change per 2 months and CD4:CD8 ratio were identified for PFS, while CA19-9, local therapy, operation, weight change per 2 months and CD4:CD8 ratio were identified for OS. The C-index for the nomograms of PFS and OS were 0.709 and 0.755, respectively. Conclusion Nomograms were developed from clinical features and nutritional indicators to predict the probability of achieving 2-month and 4-month PFS and 6-month and 12-month OS with chemotherapy for advanced PC. In advanced pancreatic cancer with limited treatment options, screening for patients who may benefit from chemotherapy is important.