3-year survival after resection in patients with pancreatic cancer

Evidencio uses JavaScript for many of its features. Please enable JavaScript to enable calculations

An update of the current model is available by clicking this link

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.

Public
Surgery
{{ modelType }}

Details
Validate model
Save input
Load input

Details
Validate model
Save input
Load input

Estimated 3-years survival after pancreatoduodenectomy:

Estimated 3-years survival after pancreatoduodenectomy: %

Result interval {{ additionalResult.min }} to {{ additionalResult.max }}

Conditional information

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.

Note

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

This model is provided for educational, training and information purposes. It must not be used to support medical decision making, or to provide medical or diagnostic services. Read our full disclaimer.

Underlying models Part of

Comments

Comment

Please enter a comment

Comments are visible to anyone

Model feedback

No feedback yet 1 Comment {{ model.comments.length }} Comments

On {{ comment.created_at }} {{ comment.user.username }} a no longer registered author wrote:

Additional information

Details

Model author

Dr. M.G. Besselink

Model ID

637

Version

1.24

Revision date

2020-01-15

Specialty

Surgery

Model type

Custom model (Conditional)

MeSH terms

Pancreatic Cancer

Survival

Lymph Nodes

Nomograms

Rating

Status

Public

Condition	Formula

Study characteristics

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

Males: {{ model.numberOfMales }}

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	Q1	Median	Q3	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
American Society of Anesthesiologists (ASA) grade	ASA II	211
American Society of Anesthesiologists (ASA) grade	ASA III/IV	64
Jaundice	Yes	288
Jaundice	No	62
Preoperative drainage	Yes	224
Preoperative drainage	No	126
Resection procedure	Whipple	48
Resection procedure	PPPD	302
Adjuvant therapy	Yes	123
Adjuvant therapy	No	227
Overall morbidity	Yes	184
Overall morbidity	No	166
Surgical morbidity	Yes	143
Surgical morbidity	No	207
In-hospital mortality	Yes	4
In-hospital mortality	No	346
Resection margin	R0	141
Resection margin	R1	198
Resection margin	R2	11
TNM classification	T1	35
TNM classification	T2	84
TNM classification	T3	223
TNM classification	T4	6
TNM classification	Tx	2
TNM classification	N0	98
TNM classification	N1	252
TNM classification	M0	342
TNM classification	M1	8
Perineural growth	Yes	107
Perineural growth	No	243
Angioinvasion	Yes	60
Angioinvasion	No	290
Tumor differentiation	Grade I (well)	28
Tumor differentiation	Grade II (moderate)	199
Tumor differentiation	Grade III (poor)	123

Supporting Publications

Title or description

Related files

Preview

Name

Please sign in to enable Evidencio print features

In order to use the Evidencio print features, you need to be logged in.
If you don't have an Evidencio Community Account you can create your free personal account at:

https://www.evidencio.com/registration

Printed results - Examples {{ new Date().toLocaleString() }}

Evidencio Community Account Benefits

With an Evidencio Community account you can:

Create and publish your own prediction models.
Share your prediction models with your colleagues, research group, organization or the world.
Review and provide feedback on models that have been shared with you.
Validate your models and validate models from other users.
Find models based on Title, Keyword, Author, Institute, or MeSH classification.
Use and save prediction models and their data.
Use patient specific protocols and guidelines based on sequential models and decision trees.
Stay up-to-date with new models in your field as they are published.
Create your own lists of favorite models and topics.

A personal Evidencio account is free, with no strings attached!
Join us and help create clarity, transparency, and efficiency in the creation, validation, and use of medical prediction models.

Disclaimer: Calculations alone should never dictate patient care, and are no substitute for professional judgement.