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Authors Pu N, Li JA, Xu YL, Lee WL, Fang Y, Han X, Zhao GC, Zhang L, Nuerxiati A, Yin HL, Wu WC, Lou WH
Received 23 November 2017
Accepted for publication 22 December 2017
Published 5 February 2018 Volume 2018:10 Pages 227—238
DOI https://doi.org/10.2147/CMAR.S157940
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Antonella D'Anneo
Background: The prognosis of pancreatic carcinoma (PC) remains poor and the American
Joint Committee on Cancer (AJCC) 8th staging system for survival prediction in
PC patients after curative resection is still limited. Thus, the aim of this
study is to refine a valuable prognostic model and novel staging system for PC
with curative resection.
Methods: The data of 3,458 patients used in this study were
retrieved from the Surveillance, Epidemiology, and End Results database
registry of National Cancer Institute. The prognostic value of lymph node ratio
(LNR) was analyzed in the primary cohort and prognostic nomogram based on the
LNR was established to create a novel staging system. Then, analyses were
conducted to evaluate the application of the formulated nomogram staging system
and the AJCC 8th staging system. The predictive performance of model was
further validated in the internal validation cohort.
Results: Significant positive correlations were found
between LNR and all factors except for surgical procedures. The results of
univariate and multivariate analyses showed that LNR was identified as an
independent prognostic indicator for overall survival (OS) in both primary and
validation cohorts (all P <
0.001). A prognostic nomogram based on the LNR was formulated to obtain
superior discriminatory abilities. Compared with the AJCC 8th staging system,
the formulated nomogram staging system showed higher hazard ratios of stage II,
III, and IV disease (reference to stage I disease) that were 1.637, 2.300, and
3.521, respectively, by univariate analyses in the primary cohort and the
distinction between stage I, II, and III disease at the beginning or end of the
survival curves was more apparent. All these results were further verified in
the validation cohort.
Conclusion: LNR can be considered as a useful independent
prognostic indicator for PC patients after curative resection regardless of the
surgical procedures. Compared with the AJCC 8th staging system, the formulated
nomogram showed superior predictive accuracy for OS and its novel staging
system revealed better risk stratification.
Keywords: pancreatic head
carcinoma, lymph node ratio, nomogram, prognosis, decision curve analysis, AJCC