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.
Version: 1.24
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Estimated 3-years survival after pancreatoduodenectomy: %

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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).

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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