3-year survival after resection in patients with pancreatic cancer

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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 Formula Study characteristics Files & References

★★★

Model author

Dr. M.G. Besselink

Model ID

637

Version

1.24

Revision date

2020-01-15

Specialty

Surgery

MeSH terms

Pancreatic Cancer

Survival

Lymph Nodes

Nomograms

Model type

Custom model (Conditional)

Status

public

Rating

★ ★ ★

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	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
	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

	3-year survival after resection in patients with pancreatic cancer
	V-1.24-637.20.01.15
	Refer to Intended Use for instructions before use
	Evidencio B.V., Irenesingel 19, 7481 GJ, Haaksbergen, the Netherlands

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Estimated 3-years survival after pancreatoduodenectomy:
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Result

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Estimated 3-years survival after pancreatoduodenectomy: %

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 <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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Related validations

International validation and update of the Amsterdam model for prediction of survival after pancreatoduodenectomy for pancreatic cancer

Validation cohort size: 3081

C-Index: Not specified

Validation author: svanroessel

Revision date:

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