3-year survival after resection in patients with pancreatic cancer: updated

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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

Public
Surgery
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Estimated 3-years survival after pancreatoduodenectomy:

Estimated 3-years survival after pancreatoduodenectomy: %

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Conditional information

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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Additional information

Details

Model author

svanroessel

Model ID

1739

Version

1.17

Revision date

2020-01-15

Specialty

Surgery

Model type

Custom model (Conditional)

MeSH terms

Survival

Lymph Nodes

Nomograms

Pancreatic Cancer

Rating

Status

Public

Condition	Formula

Study characteristics

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

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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
Margin status	R1	1296
N stage (8th edition)	N0	663
N stage (8th edition)	N1	1251
N stage (8th edition)	N2	1167
Tumor grade	Grade I (well)	192
Tumor grade	Grade II (moderately)	1848
Tumor grade	Grade III (poorly)	1041
Adjuvant therapy	Yes	2359
Adjuvant therapy	No	722

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