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Development and validation of a predictive model for portal-systemic venous invasion grading in borderline resectable pancreatic cancer.
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Wang Fang-Fei, Dai Xiao-Di, Zhao Xin, He Qiang, Lyu Shao-Cheng
Аннотация
BACKGROUND: Portosystemic venous invasion (PSVI) depth critically influences prognosis in borderline resectable pancreatic cancer (BRPC), necessitating precise preoperative discrimination for personalized therapy.
AIM: To develop and validate a preoperative nomogram integrating computed tomography parameters and carbohydrate antigen 19-9 (CA19-9) kinetics for predicting PSVI depth in treatment-naive BRPC.
METHODS: This retrospective cohort study analyzed 167 BRPC patients undergoing radical resection between 2011 and 2023. Patients were stratified by pathological PSVI depth [no venous invasion (VI)/adventitial/muscularis propria/intimal]. Kaplan-Meier and ordinal logistic regression identified preoperative predictors from clinical/laboratory/computed tomography parameters (e.g., circumferential involvement and CA19-9). A nomogram was developed and validated via calibration curves/decision curve analysis.
RESULTS: PSVI depth significantly stratified survival.: Intimal VI showed worst prognosis (median overall survival: 9 months, 5-year overall survival: 0% vs no VI: 17 months, 12.5%; P < 0.001). Independent predictors: CA19-9 [odds ratio (OR) = 3.819, Wald = 14.125, 95% confidence interval (CI): 1.980-7.410], circumferential involvement (OR = 8.271, Wald = 33.352, 95%CI: 3.950-17.320), and luminal compromise (OR = 3.544, Wald = 8.489, 95%CI: 1.818-6.447). The nomogram achieved C-index = 0.928 (95%CI: 0.889-0.967), with 100-250 points indicating high invasiveness risk. Decision curve analysis confirmed clinical utility (threshold: 0-0.7).
CONCLUSION: This model integrates routine indicators to preoperatively quantify PSVI depth, guiding precision treatment.
AIM: To develop and validate a preoperative nomogram integrating computed tomography parameters and carbohydrate antigen 19-9 (CA19-9) kinetics for predicting PSVI depth in treatment-naive BRPC.
METHODS: This retrospective cohort study analyzed 167 BRPC patients undergoing radical resection between 2011 and 2023. Patients were stratified by pathological PSVI depth [no venous invasion (VI)/adventitial/muscularis propria/intimal]. Kaplan-Meier and ordinal logistic regression identified preoperative predictors from clinical/laboratory/computed tomography parameters (e.g., circumferential involvement and CA19-9). A nomogram was developed and validated via calibration curves/decision curve analysis.
RESULTS: PSVI depth significantly stratified survival.: Intimal VI showed worst prognosis (median overall survival: 9 months, 5-year overall survival: 0% vs no VI: 17 months, 12.5%; P < 0.001). Independent predictors: CA19-9 [odds ratio (OR) = 3.819, Wald = 14.125, 95% confidence interval (CI): 1.980-7.410], circumferential involvement (OR = 8.271, Wald = 33.352, 95%CI: 3.950-17.320), and luminal compromise (OR = 3.544, Wald = 8.489, 95%CI: 1.818-6.447). The nomogram achieved C-index = 0.928 (95%CI: 0.889-0.967), with 100-250 points indicating high invasiveness risk. Decision curve analysis confirmed clinical utility (threshold: 0-0.7).
CONCLUSION: This model integrates routine indicators to preoperatively quantify PSVI depth, guiding precision treatment.