Nederlands
| Condition | Formula |
|---|---|
Additional information
Study population:Between 1992 and 2012, a consecutive series of patients with pancreatic ductal adenocarcinoma (PDAC) who underwent pancreatoduodenectomy at the Academic Medical Centre, Amsterdam, The Netherlands, were included in the present study. A total of 350 patients were eligible for analysis.
Study protocol:
All patients with pancreatic cancer operated on with pancreatoduodenectomy were selected from a database. Clinicopathological characteristics were analysed. Microscopic positive resection margin was defined as the microscopic presence of tumour cells within 1 mm of the margins. A nomogram was created.
Primary endpoints:
The primary endpont of the study was 3-year surival after resection in patients with pancreatic cancer. Mortality was defined as death during the initial admission after the index operation.
Statistical analysis:
A nomogram for 3-year survival rates was created based on the outcomes after multivariable Cox regression analysis, through a stepwise approach, using known predictors of survival from the literature (resection margin, perineural growth and angioinvasion) and factors that were of borderline significance (P <0.200) in a univariable Coxregression analysis. Significant predictive factors for 3-year survival after multivariable Cox regression analysis were then used to create the nomogram
Source:
Tol JA, Brosens LA, van Dieren S, et al. Impact of lymph node ratio on survival in patients with pancreatic and periampullary cancer. Br J Surg. 2015;102(3):237-45.
Study Population
Total population size: 350Continuous characteristics
| Name | Mean | SD | Unit |
|---|---|---|---|
| Age | 64 | 10 | years |
| Body mass index (BMI) | 24 | 6 | kg/m2 |
| Tumor size | 2.8 | 1.5 | cm |
| Name | LL | Q1 | Median | Q3 | UL | Unit |
|---|---|---|---|---|---|---|
| Number of lymph nodes | 5 | 8 | 13 | nodes | ||
| Hospital stay | 10 | 14 | 19 | days | ||
| Lymph node ratio (positive lymph nodes/total number of lymph nodes) | 0 | 0.2 | 0.4 | ratio |
Categorical characteristics
| Name | Subset / Group | Nr. of patients |
|---|---|---|
| American Society of Anesthesiologists (ASA) grade | ASA I | 75 |
| ASA II | 211 | |
| ASA III/IV | 64 | |
| Jaundice | Yes | 288 |
| No | 62 | |
| Preoperative drainage | Yes | 224 |
| No | 126 | |
| Resection procedure | Whipple | 48 |
| PPPD | 302 | |
| Adjuvant therapy | Yes | 123 |
| No | 227 | |
| Overall morbidity | Yes | 184 |
| No | 166 | |
| Surgical morbidity | Yes | 143 |
| No | 207 | |
| In-hospital mortality | Yes | 4 |
| No | 346 | |
| Resection margin | R0 | 141 |
| R1 | 198 | |
| R2 | 11 | |
| TNM classification | T1 | 35 |
| T2 | 84 | |
| T3 | 223 | |
| T4 | 6 | |
| Tx | 2 | |
| N0 | 98 | |
| N1 | 252 | |
| M0 | 342 | |
| M1 | 8 | |
| Perineural growth | Yes | 107 |
| No | 243 | |
| Angioinvasion | Yes | 60 |
| No | 290 | |
| Tumor differentiation | Grade I (well) | 28 |
| Grade II (moderate) | 199 | |
| Grade III (poor) | 123 |
Related files
| Preview | Name | Tags |
|---|---|---|
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4.96 kB | Institute Logo |
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Kaplan Meier curve (Tol et al, 2015).png 24.54 kB |
Figure (results-page) Kaplan Meier plot |
Supporting Publications
| Title or description | Tags |
|---|---|
| Original paper: Tol JA, Brosens LA, van Dieren S, et al. Impact of lymph node ratio on survival in patients with pancreatic and periampullary cancer. Br J Surg. 2015;102(3):237-45. | Internal validation Paper Peer review |
Estimated 3-years survival after pancreatoduodenectomy: ... %
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Estimated 3-years survival after pancreatoduodenectomy: %
Outcome stratification
Conditional information
Result interpretation
How this model should be used:
This model calculates 3-year survival after resection in patients with pancreatic cancer. The value of the model needs to be confirmed in independent study populations.
Lymph node ratio:
Lymph node ratio (LNR) was identified as a strong predictor of survival in patients with pancreatic cancer. LNR is calculated by dividing the number of positive lymph nodes by the total number of lymph nodes. The optimal cut-off value for LNR was 0.18. In patients with a LNR of 0.18 or less, median survival was 26 months versus 16 months in patients with a LNR greater than 0.18 (P <0⋅001).
Model performance:
Predictive factors for death in patients (n=350) with pancreatic ductal adenocarcinoma included in the nomogram were: R1 resection (hazard ratio (HR) 1.55, 95% CI: 1.07 to 2.25), poor tumour differentiation (HR 2.78, 1.40 to 5.52), LNR above 0.18 (HR 1.75, 1.13 to 2.70) and no adjuvant therapy (HR 1.54, 1.01 to 2.34). The C-statistic was 0.658 (0.632 to 0.698), and calibration was good (Hosmer–Lemeshow χ2 =5.67, P=0.773).
Source:
Tol JA, Brosens LA, van Dieren S, et al. Impact of lymph node ratio on survival in patients with pancreatic and periampullary cancer. Br J Surg. 2015;102(3):237-45.
Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.
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