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Development and validation of a nomogram to predict liver metastasis in patients with pancreatic ductal adenocarcinoma: a large cohort study

Authors He C, Zhong L, Zhang Y, Cai Z, Lin X

Received 7 January 2019

Accepted for publication 29 March 2019

Published 2 May 2019 Volume 2019:11 Pages 3981—3991


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Dr Ahmet Emre Eskazan

Chaobin He,1.* Lixin Zhong,2,* Yu Zhang,3,* Zhiyuan Cai,1 Xiaojun Lin1
1Department of Hepatobiliary and Pancreatic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People’s Republic of China; 2Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, People’s Republic of China; 3State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, People’s Republic of China

*These authors contributed equally to this work
Background: Few studies have explored the relationship between clinicopathological factors of patients with pancreatic ductal adenocarcinoma (PDAC) and liver metastasis. The aim of this study was to develop and validate a nomogram to predict liver metastasis in patients with PDAC.
Patients and methods: Patients diagnosed with PDAC between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively collected. The nomogram was established based on a logistic regression model. The precision of the nomogram was evaluated and compared using concordance index (C-index), and the area under receiver operating characteristic curve (AUC). The clinical use of nomogram was evaluated by making use of a decision curve analysis (DCA).
Results: A total of 12,644 eligible patients, which were randomly divided into training (n=9,483) and validation cohorts (n=3,161), were included in this study. The nomograms, which were established on the basis of independent predictors, were well calibrated, and demonstrated good discriminative ability, with C-indexes of 0.784 for the training cohort and 0.790 for validation cohort. The values of AUC for training and validation cohort were 0.792 and 0.800, respectively. When other sites of distant metastases were included into this predictive system, the new predictive model demonstrated a better discriminative ability and greater net benefit in predicting liver metastasis in patients with PDAC in both the training and validation cohorts.
Conclusion: Nomograms were constructed to predict liver metastasis in patients with PDAC. Validation revealed excellent discrimination and calibration of the nomograms, suggesting that the nomograms were well calibrated and could serve to improve the prediction of the risks of liver metastasis which can be used to guide the management of patients with PDAC.

Keywords: pancreatic ductal adenocarcinoma, liver metastasis, predictor, nomogram, SEER

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