3-year survival after resection in patients with pancreatic cancer: updated amsterdam model
This prediction model for 3-year survival after resection in patients with pancreatic cancer was developed in 2015 in Amsterdam UMC (location AMC) and externally validated in 2019 in 3081 patients from 8 countries (USA, UK, Germany, Italy, Sweden, the Netherlands, Korea, Australia).

PubMed ID 31924432
Research authors: van Roessel, S, Strijker, M, Steyerberg, EW, ..., Besselink, MG
Details Formula Study characteristics Files & References
★★★★★
Model author
Model ID
1739
Version
1.17
Revision date
2020-01-15
Specialty
MeSH terms
  • Survival
  • Lymph Nodes
  • Nomograms
  • Pancreatic Cancer
  • Model type
    Custom model (Conditional)
    Status
    public
    Rating
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    Condition Formula

    Additional information

    Background
    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.

    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.

    Source: 
    van Roessel S, Strijker M, Steyerberg EW, et al. International validation and update of the Amsterdam model for prediction of survival after pancreatoduodenectomy for pancreatic cancer. European Journal of Surgical Oncology: the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2019.

    Study Population

    Total population size: 3081
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name LL Q1 Median Q3 UL Unit
    Age 59 66 72 years

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Margin status R0 1785
    R1 1296
    N stage (8th edition) N0 663
    N1 1251
    N2 1167
    Tumor grade Grade I (well) 192
    Grade II (moderately) 1848
    Grade III (poorly) 1041
    Adjuvant therapy Yes 2359
    No 722

    Related files

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    Estimated 3-years survival after pancreatoduodenectomy:
    ...
    %

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    Result
    Note
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    Estimated 3-years survival after pancreatoduodenectomy: %

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    Outcome stratification

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    Conditional information

    Result interpretation

    How this model should be used: 
    This validated model calculates 3-year survival after resection in patients with pancreatic cancer.

    Model performance:
    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).

    Source: 
    van Roessel S, Strijker M, Steyerberg EW, et al. International validation and update of the Amsterdam model for prediction of survival after pancreatoduodenectomy for pancreatic cancer. European Journal of Surgical Oncology: the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2019.

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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