3-year survival after resection in patients with pancreatic cancer
Predicts 3-year survival after resection in patients with pancreatic cancer based on lymph node ratio. This model includes the number of lymph nodes with metastases in relation to the total number of removed lymph nodes, the lymph node ratio (LNR), as one of the most powerful predictors of survival.
Research authors: Toll, JAMG, Brosens, LAA, van DIeren S, van Gulik TM, Busch ORC, Besselink MGH, and Gouma Dj.
Details Custom formula Study characteristics Files & References
★★★
Model author
Model ID
637
Version
1.22
Revision date
2018-06-04
Specialty
MeSH terms
  • Pancreatic Cancer
  • Survival
  • Lymph Nodes
  • Nomograms
  • Model type
    Custom model (Conditional)
    Status
    public
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    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: 350
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    Females: {{ model.numberOfFemales }}

    Continuous 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

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

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    Result
    Note
    Notes are only visible in the result download and will not be saved by Evidencio

    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 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 <0001).

    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.

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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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