Development, validation, and comparison of a nomogram based on radiologic findings for predicting malignancy in intraductal papillary mucinous neoplasms of the pancreas: An international multicenter study.
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Kim Hyeong Seok, Song Wookyeong, Choo Wonho, Lee Sungyoung, Han Youngmin, Bassi Claudio, Salvia Roberto, Marchegiani Giovanni, Wolfgang Christopher L, He Jin, Blair Alex B, Kluger Michael D, Su Gloria H, Kim Song Cheol, Song Ki-Byung, Yamamoto Masakazu, Hatori Takashi, Yang Ching-Yao, Yamaue Hiroki, Hirono Seiko, Satoi Sohei, Fujii Tsutomu, Hirano Satoshi, Lou Wenhui, Hashimoto Yasushi, Shimizu Yasuhiro, Del Chiaro Marco, Valente Roberto, Lohr Matthias, Choi Dong Wook, Choi Seong Ho, Heo Jin Seok, Motoi Fuyuhiko, Matsumoto Ippei, Lee Woo Jung, Kang Chang Moo, Shyr Yi-Ming, Wang Shin-E, Han Ho-Seong, Yoon Yoo-Seok, Besselink Marc G, van Huijgevoort Nadine C M, Sho Masayuki, Nagano Hiroaki, Kim Sang Geol, Honda Goro, Yang Yinmo, Yu Hee Chul, Yang Jae Do, Chung Jun Chul, Nagakawa Yuichi, Seo Hyung Il, Lee Seungyeoun, Kim Hongbeom, Kwon Wooil, Park Taesung, Jang Jin-Young
Аннотация
METHODS: We recruited 3708 patients who underwent surgical resection at 31 tertiary institutions in eight countries, and patients with main pancreatic duct >10 mm were excluded. To construct the nomogram, 2606 patients were randomly allocated 1:1 into training and internal validation sets, and area under the receiver operating characteristics curve (AUC) was calculated using 10-fold cross validation by exhaustive search. This nomogram was then validated and compared to the American and Korean/Japanese nomograms using 1102 patients.
RESULTS: Among the 2606 patients, 90 had main-duct type, 900 had branch-duct type, and 1616 had mixed-type IPMN. Pathologic results revealed 1628 low-grade dysplasia, 476 high-grade dysplasia, and 502 invasive carcinoma. Location, cyst size, duct dilatation, and mural nodule were selected to construct the nomogram. AUC of this nomogram was higher than the American nomogram (0.691 vs 0.664, P = .014) and comparable with the Korean/Japanese nomogram (0.659 vs 0.653, P = .255).
CONCLUSIONS: A novel nomogram based on radiologic findings of IPMN is competitive for predicting risk of malignancy. This nomogram would be clinically helpful in circumstances where tumor markers are not available. The nomogram is freely available at http://statgen.snu.ac.kr/software/nomogramIPMN.