Accuracy of models to prognosticate survival after surgery for pancreatic cancer in the era of neoadjuvant therapy

Clayton T. Marcinak, William F. Parker, Alexander A. Parikh, Jashodeep Datta, Shishir K. Maithel, David A. Kooby, Mark E. Burkard, Hong Jin Kim, Michael T. LeCompte, Majid Afshar, Matthew M. Churpek, Syed Nabeel Zafar

Producción científica: Articlerevisión exhaustiva

Resumen

Background: Outcomes for pancreatic adenocarcinoma (PDAC) remain difficult to prognosticate. Multiple models attempt to predict survival following the resection of PDAC, but their utility in the neoadjuvant population is unknown. We aimed to assess their accuracy among patients that received neoadjuvant chemotherapy (NAC). Methods: We performed a multi-institutional retrospective analysis of patients who received NAC and underwent resection of PDAC. Two prognostic systems were evaluated: the Memorial Sloan Kettering Cancer Center Pancreatic Adenocarcinoma Nomogram (MSKCCPAN) and the American Joint Committee on Cancer (AJCC) staging system. Discrimination between predicted and actual disease-specific survival was assessed using the Uno C-statistic and Kaplan–Meier method. Calibration of the MSKCCPAN was assessed using the Brier score. Results: A total of 448 patients were included. There were 232 (51.8%) females, and the mean age was 64.1 years (±9.5). Most had AJCC Stage I or II disease (77.7%). For the MSKCCPAN, the Uno C-statistic at 12-, 24-, and 36-month time points was 0.62, 0.63, and 0.62, respectively. The AJCC system demonstrated similarly mediocre discrimination. The Brier score for the MSKCCPAN was 0.15 at 12 months, 0.26 at 24 months, and 0.30 at 36 months, demonstrating modest calibration. Conclusions: Current survival prediction models and staging systems for patients with PDAC undergoing resection after NAC have limited accuracy.

Idioma originalEnglish (US)
Páginas (desde-hasta)280-288
Número de páginas9
PublicaciónJournal of Surgical Oncology
Volumen128
N.º2
DOI
EstadoPublished - ago 2023
Publicado de forma externa

ASJC Scopus subject areas

  • Oncology
  • Surgery

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