International validation and update of the Amsterdam model for prediction of survival after pancreatoduodenectomy for pancreatic cancer.

Aged Antineoplastic Agents / therapeutic use Area Under Curve Capecitabine / therapeutic use Carcinoma, Pancreatic Ductal / mortality Chemoradiotherapy, Adjuvant Chemotherapy, Adjuvant Clinical Decision Rules Deoxycytidine / analogs & derivatives Female Fluorouracil / therapeutic use Humans Internationality Lymph Nodes / pathology Male Margins of Excision Middle Aged Neoadjuvant Therapy Neoplasm Grading Neoplasm Invasiveness Neoplasm Staging Pancreatic Neoplasms / mortality Pancreaticoduodenectomy Radiotherapy Reproducibility of Results Retrospective Studies Gemcitabine

International Pancreatic cancer Pancreatoduodenectomy Prediction model Survival Validation

Journal

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

ISSN: 1532-2157

Titre abrégé: Eur J Surg Oncol

Pays: England

ID NLM: 8504356

Informations de publication

Date de publication:
05 2020

Historique:

received: 04 07 2019

revised: 20 11 2019

accepted: 24 12 2019

pubmed: 12 1 2020

medline: 18 12 2020

entrez: 12 1 2020

Statut: ppublish

Résumé

The objective of this study was to validate and update the Amsterdam prediction model including tumor grade, lymph node ratio, margin status and adjuvant therapy, for prediction of overall survival (OS) after pancreatoduodenectomy for pancreatic cancer. We included consecutive patients who underwent pancreatoduodenectomy for pancreatic cancer between 2000 and 2017 at 11 tertiary centers in 8 countries (USA, UK, Germany, Italy, Sweden, the Netherlands, Korea, Australia). Model performance for prediction of OS was evaluated by calibration statistics and Uno's C-statistic for discrimination. Validation followed the TRIPOD statement. Overall, 3081 patients (53% male, median age 66 years) were included with a median OS of 24 months, of whom 38% had N2 disease and 77% received adjuvant chemotherapy. Predictions of 3-year OS were fairly similar to observed OS with a calibration slope of 0.72. Statistical updating of the model resulted in an increase of the C-statistic from 0.63 to 0.65 (95% CI 0.64-0.65), ranging from 0.62 to 0.67 across different countries. The area under the curve for the prediction of 3-year OS was 0.71 after updating. Median OS was 36, 25 and 15 months for the low, intermediate and high risk group, respectively (P < 0.001). This large international study validated and updated the Amsterdam model for survival prediction after pancreatoduodenectomy for pancreatic cancer. The model incorporates readily available variables with a fairly accurate model performance and robustness across different countries, while novel markers may be added in the future. The risk groups and web-based calculator www.pancreascalculator.com may facilitate use in daily practice and future trials.

Sections du résumé

BACKGROUND

METHODS

We included consecutive patients who underwent pancreatoduodenectomy for pancreatic cancer between 2000 and 2017 at 11 tertiary centers in 8 countries (USA, UK, Germany, Italy, Sweden, the Netherlands, Korea, Australia). Model performance for prediction of OS was evaluated by calibration statistics and Uno's C-statistic for discrimination. Validation followed the TRIPOD statement.

RESULTS

Overall, 3081 patients (53% male, median age 66 years) were included with a median OS of 24 months, of whom 38% had N2 disease and 77% received adjuvant chemotherapy. Predictions of 3-year OS were fairly similar to observed OS with a calibration slope of 0.72. Statistical updating of the model resulted in an increase of the C-statistic from 0.63 to 0.65 (95% CI 0.64-0.65), ranging from 0.62 to 0.67 across different countries. The area under the curve for the prediction of 3-year OS was 0.71 after updating. Median OS was 36, 25 and 15 months for the low, intermediate and high risk group, respectively (P < 0.001).

CONCLUSIONS

This large international study validated and updated the Amsterdam model for survival prediction after pancreatoduodenectomy for pancreatic cancer. The model incorporates readily available variables with a fairly accurate model performance and robustness across different countries, while novel markers may be added in the future. The risk groups and web-based calculator www.pancreascalculator.com may facilitate use in daily practice and future trials.

Identifiants

DOI: 10.1016/j.ejso.2019.12.023 PMID: 31924432

pubmed: 31924432

pii: S0748-7983(19)31519-7

doi: 10.1016/j.ejso.2019.12.023

pii:

doi:

Substances chimiques

Antineoplastic Agents 0

Deoxycytidine 0W860991D6

Capecitabine 6804DJ8Z9U

Fluorouracil U3P01618RT

Gemcitabine 0

Types de publication

Journal Article Validation Study

Langues

eng

Sous-ensembles de citation

Pagination

796-803

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of competing interest None.