Development and external validation of a prediction model for survival in patients with resected ampullary adenocarcinoma.
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Moekotte Alma L, van Roessel Stijn, Malleo Giuseppe, Rajak Rushda, Ecker Brett L, Fontana Martina, Han Ho-Seong, Rabie Mohamed, Roberts Keith J, Khalil Khalid, White Steven A, Robinson Stuart, Halimi Asif, Zarantonello Laura, Fusai Giuseppe K, Gradinariu George, Alseidi Adnan, Bonds Morgan, Dreyer Stephan, Jamieson Nigel B, Mowbray Nicholas, Al-Sarireh Bilal, Mavroeidis Vasileios K, Soonawalla Zahir, Napoli Niccolò, Boggi Ugo, Kent Tara S, Fisher William E, Tang Chung N, Bolm Louisa, House Michael G, Dillhoff Mary E, Behrman Stephen W, Nakamura Masafumi, Ball Chad G, Berger Adam C, Christein John D, Zureikat Amer H, Salem Ronald R, Vollmer Charles M, Salvia Roberto, Besselink Marc G, Abu Hilal Mohammed, International Study Group on Ampullary Cancer (ISGACA) Collaborators, Aljarrah Ra'ed, Barrows Courtney, Cagigas Martha Navarro, Lai Eric C H, Wellner Ulrich, Aversa John, Dickson Paxton V, Ohtsuka Takao, Dixon Elijah, Zheng Richard, Kowalski Stacy, Freedman-Weiss Mollie
Аннотация
MATERIALS AND METHODS: An international multicenter cohort study was conducted, including patients who underwent pancreatoduodenectomy for AAC (2006-2017) from 27 centers in 10 countries spanning three continents. A derivation and validation cohort were separately collected. Predictors were selected from the derivation cohort using a LASSO Cox proportional hazards model. A nomogram was created based on shrunk coefficients. Model performance was assessed in the derivation cohort and subsequently in the validation cohort, by calibration plots and Uno's C-statistic. Four risk groups were created based on quartiles of the nomogram score.
RESULTS: Overall, 1007 patients were available for development of the model. Predictors in the final Cox model included age, resection margin, tumor differentiation, pathological T stage and N stage (8th AJCC edition). Internal cross-validation demonstrated a C-statistic of 0.75 (95% CI 0.73-0.77). External validation in a cohort of 462 patients demonstrated a C-statistic of 0.77 (95% CI 0.73-0.81). A nomogram for the prediction of 3- and 5-year survival was created. The four risk groups showed significantly different 5-year survival rates (81%, 57%, 22% and 14%, p < 0.001). Only in the very-high risk group was adjuvant chemotherapy associated with an improved overall survival.
CONCLUSION: A prediction model for survival after curative resection of AAC was developed and externally validated. The model is easily available online via www.pancreascalculator.com.