Establishment and application of preoperative prognostic model for resectable pancreatic cancer

doi:10.3877/cma.j.issn.1674-3946.2023.05.025

Abstract

Abstract:

Objective

A mathematical model was established before operation to provide reference for treatment decision of patients with resectable pancreatic cancer.

Method

The clinical data of 120 patients with resectable pancreatic ductal adenocarcinoma（PDAC）who met the study criteria and were admitted from January 2011 to June 2018 were retrospectively analyzed. The patients' clinical data were divided into two groups with high and low survival，with the survival period less than 20 months as the limit. Statistical analysis was performed using SAS 9.4（Cary，NC），univariate analysis and multivariate regression analysis were used by Log-Rank method to determine independent risk factors for poor prognosis of pancreatic cancer，and then a risk prediction model for poor prognosis of pancreatic cancer（<20 months）was established. P<0.05 was considered to be statistically significant.

Results

Univariate and multifactorial Logistic regression analysis showed that SIII，CA19-9 and tumor size were independent risk factors for poor prognosis of pancreatic cancer（<20 months）（P<0.05）. After fitting，the formula model for predicting adverse prognosis of pancreatic cancer was obtained：Log（p/1-p）=-5.825+0.004× SIII+0.002×CA199+0.822× tumor size；The area under the training suite was 0.872（95%CI 0.7977-0.946），P<0.001，sensitivity was 0.824，specificity was 0.818；Hosmer-Lemeshow goodness of fit test χ²=3.031，P=0.932.

Conclusions

This prediction model can evaluate the prognosis and survival of patients with resectable PDAC before surgery，and at the same time screen resectable PDAC，so as to provide a certain reference for the treatment decision of patient.

Key words: Pancreatic Neoplasms, Prognosis, Tumor Size, Systemic Immune Inflammation Index, Prediction Model

Chengpeng Jia, Daihong Wang, Hua Chen, Bei Sun. Establishment and application of preoperative prognostic model for resectable pancreatic cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(05): 566-570.

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References 34

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术前临床因素	低生存期组(n=51)	高生存期组 (n=33)	t/χ²值	P值
性别			2.335	0.127
女	24(47.1)	10(30.3)
男	27(53.0)	23(69.7)
年龄	56.5±11.3	57.1±10.3	-0.240	0.809
前白蛋白(mg/l)	153.1±55.9	162.1±66.7	-0.650	0.516
白蛋白(g/l)	39.6±4.3	40.0±5.0	-0.850	0.396
碱性磷酸酶(u/l)	328.6±221.7	309.0±265.2	0.380	0.704
CA19-9(U/ml)	435.5±387.7	172.7±216.0	3.980	0.021
CEA(ng/ml)	6.6±15.2	3.3±2.4	1.520	0.134
肿瘤大小(cm)	3.8±0.8.7	3.2±0.8	3.350	0.001
中性粒细胞(数目/μl)	3990.2±1351.1	3327.3±1121.1	2.370	0.020
淋巴细胞(数目/μl)	1350.2±401.5	1538.7±420.6	-1.990	0.051
血小板(×10⁴/μl)	26.2±7.9	21.4±6.8	2.880	0.005
总胆红素(μmol/l)	116.3±109.0	107.5±122.1	0.350	0.731
NLR	3.1±1.0	2.3±0.8	4.110	0.001
PLR	209.1±78.1	146.9±53.9	4.320	0.002
预后营养指数(PNI)	45.9±4.6	47.7±5.4	-1.630	0.107
系统免疫炎症指数(SIII)	819.9±370.8	476.0±197.8	5.520	0.013

术前临床因素	低生存期组(n=51)	高生存期组 (n=33)	t/χ²值	P值
性别			2.335	0.127
女	24(47.1)	10(30.3)
男	27(53.0)	23(69.7)
年龄	56.5±11.3	57.1±10.3	-0.240	0.809
前白蛋白(mg/l)	153.1±55.9	162.1±66.7	-0.650	0.516
白蛋白(g/l)	39.6±4.3	40.0±5.0	-0.850	0.396
碱性磷酸酶(u/l)	328.6±221.7	309.0±265.2	0.380	0.704
CA19-9(U/ml)	435.5±387.7	172.7±216.0	3.980	0.021
CEA(ng/ml)	6.6±15.2	3.3±2.4	1.520	0.134
肿瘤大小(cm)	3.8±0.8.7	3.2±0.8	3.350	0.001
中性粒细胞(数目/μl)	3990.2±1351.1	3327.3±1121.1	2.370	0.020
淋巴细胞(数目/μl)	1350.2±401.5	1538.7±420.6	-1.990	0.051
血小板(×10⁴/μl)	26.2±7.9	21.4±6.8	2.880	0.005
总胆红素(μmol/l)	116.3±109.0	107.5±122.1	0.350	0.731
NLR	3.1±1.0	2.3±0.8	4.110	0.001
PLR	209.1±78.1	146.9±53.9	4.320	0.002
预后营养指数(PNI)	45.9±4.6	47.7±5.4	-1.630	0.107
系统免疫炎症指数(SIII)	819.9±370.8	476.0±197.8	5.520	0.013

变量	Wald χ²值	P值	OR值(95%CI)
截断值	13.601	0.000	-
系统免疫炎症指数(SIII)	11.411	0.001	1.004(1.002-1.007)
CA19-9(U/ml)	6.634	0.010	1.002(1.001-1.004)
肿瘤大小(cm)	5.491	0.019	2.274(1.144-4.521)

变量	Wald χ²值	P值	OR值(95%CI)
截断值	13.601	0.000	-
系统免疫炎症指数(SIII)	11.411	0.001	1.004(1.002-1.007)
CA19-9(U/ml)	6.634	0.010	1.002(1.001-1.004)
肿瘤大小(cm)	5.491	0.019	2.274(1.144-4.521)

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