Development and Validation of Nomograms to Predict Overall Survival and Cancer-Specific Survival in Patients With Pancreatic Adenosquamous Carcinoma

Abstract

BackgroundPancreatic adenosquamous carcinoma (PASC) is a heterogeneous group of primary pancreatic cancers characterized by the coexistence of both glandular and squamous differentiation. The aim of this study was to develop nomograms to predict survival outcomes in patients with PASC.MethodsIn this retrospective study, data on PASC, including clinicopathological characteristics, treatments, and survival outcomes, were collected from the SEER database between 2000 and 2018. The primary endpoints were overall survival (OS) and cancer-specific survival (CSS). The eligible patients were randomly divided into development cohort and validation cohort in a 7:3 ratio. The nomograms for prediction of OS and CSS were constructed by the development cohort using a LASSO-Cox regression model, respectively. Besides the model performance was internally and externally validated by examining the discrimination, calibration, and clinical utility.ResultsA total of 632 consecutive patients who had been diagnosed with PASC were identified and randomly divided into development (n = 444) and validation (n = 188) cohorts. In the development cohort, the estimated median OS was 7.0 months (95% CI: 6.19–7.82) and the median CSS was 7.0 months (95% CI: 6.15–7.85). In the validation cohort, the estimated median OS was 6.0 months (95% CI: 4.46–7.54) and the median CSS was 7.0 months (95% CI: 6.25–7.75). LASSO-penalized COX regression analysis identified 8 independent predictors in the OS prediction model and 9 independent risk factors in the CSS prediction model: age at diagnosis, gender, year of diagnosis, tumor location, grade, stage, size, lymph node metastasis, combined metastasis, surgery, radiation, and chemotherapy. The Harrell C index and time-dependent AUCs manifested satisfactory discriminative capabilities of the models. Calibration plots showed that both models were well calibrated. Furthermore, decision curves indicated good utility of the nomograms for decision-making.ConclusionNomogram-based models to evaluate personalized OS and CSS in patients with PASC were developed and well validated. These easy-to-use tools will be useful methods to calculate individualized estimate of survival, assist in risk stratification, and aid clinical decision-making.

Development and validation of prognostic nomogram for patients with metastatic gastric adenocarcinoma based on the SEER database

“…The tumor size of the vast majority of solid tumors, such as lung cancer and breast cancer, is included in their TNM stage system to assess prognosis; the larger the tumor, the worse the prognosis. [28,29] This finding is consistent with the results of the present study. However, the T stage of gastric cancer only includes the depth of tumor invasion, and if the tumor size is used together with the depth of tumor invasion to assess prognosis, it will lead to more precise treatment for patients.…”

“…The tumor size of the vast majority of solid tumors, such as lung cancer and breast cancer, is included in their TNM stage system to assess prognosis; the larger the tumor, the worse the prognosis. [28,29] Table 3 Multivariate analysis of patients with metastatic gastric adenocarcinoma. This finding is consistent with the results of the present study.…”

A case of pancreatic adenosquamous cell carcinoma with a pseudocyst following curative surgery

“…The cancer stem cell hypothesis is considered to be the most likely pathogenic contributor, as reported in previous studies [ 12 , 13 ]. However, the association between the number of SCC components and the prognosis remains unclear.…”

Two rare cancers of the exocrine pancreas: to treat or not to treat like ductal adenocarcinoma?

“…ASCP is typically considered more aggressive than standard PDAC. Multiple registry studies that have evaluated large cohorts of patients concur that ASCP patients have similar demographic characteristics to PDAC patients, but present with larger and more poorly differentiated tumors [78][79][80][81] . Median survival in the unselected population is similar between ASCP and PDAC patients and is ~4-6 months [Table 2].…”

“…Resection is recommended for patients with early-stage disease and several population-based studies have demonstrated a significant survival advantage for patients with locoregional disease who undergo surgery versus those who do not [79][80][81] . R1 resection was associated with worse outcomes in one smaller singleinstitution study that included only one patient with this resection status [50] , but no contribution of R0 status to survival was found in two larger population-based studies [78,80] .…”