Validated Nomogram Predicting 6-Month Survival in Pancreatic Cancer Patients Receiving First-Line 5-Fluorouracil, Oxaliplatin, and Irinotecan

Abstract

Background: FOLFIRINOX is an option for fit patients with metastatic (MPC) and locally advanced unresectable (LAPC) pancreatic cancer. However, no criteria reliably identify patients with better outcome. Patients and Methods: We investigated putative prognostic factors among 137 MPC/LAPC patients treated with triplet chemotherapy. Association with 6-month survival status (primary endpoint) was assessed by multivariate logistic regression models. A nomogram predicting the risk of death at 6 months was built by assigning a numeric score to each identified variable, weighted on its level of association with survival. External validation was performed in an independent dataset of 206 patients. Results: Four variables (performance status, liver metastases, baseline CA19.9 and neutrophil-to-lymphocyte ratio) were found associated with 6-month survival by multivariate analysis or had sufficient clinical plausibility to be included in the nomogram. Accuracy was confirmed in the validation cohort (C-index 0.762; 95%CI 0.713-0.825). After grouping all cases, four subsets with different outcomes were identified by none, 1, 2 or >2 poor prognostic features (P<0.0001). Conclusion: Our nomogram accurately predicts the risk of death in the first 6 months after initiation of FOLFIRINOX in MPC/LAPC patients. This tool could be useful to guide communication about prognosis and inform the design and interpretation of clinical trials. Clinical Trial Registration: The study is registered on ClinicalTrials.gov (NCT03590275).

Nomogram to predict survival of patients with advanced and metastatic pancreatic Cancer

“…However, few studies have used nomograms to predict the survival rate of patients with advanced or metastatic PC [ 17 , 18 ]. Most models are constructed using baseline clinicopathological factors [ 19 ]. However, patient responses and sensitivity to chemotherapy are also crucial for constructing predictive models for patients undergoing chemotherapy.…”

Reactive oxygen species mediate anlotinib-induced apoptosis via activation of endoplasmic reticulum stress in pancreatic cancer

“…Despite progress in treatments, patients with PDAC respond poorly to chemotherapy, mainly due to drug resistance. First-line chemotherapy with gemcitabine 3 or the FORFIRINOX regime (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) 4 has only a 5.4% partial response rate in patients with PDAC. Hence, there is an urgent demand to enhance the treatment of this malignant cancer.…”

Recent Discoveries of Diagnostic, Prognostic and Predictive Biomarkers for Pancreatic Cancer

“…For guidance of chemotherapy regimens several nomograms have been developed. Nomograms are used to assess the efficacy of gemcitabine monotherapy, nab-paclitaxel/gemcitabine or FOLFIRINOX, which are the most widely used regimens for advanced PDAC [12,13,16]. In summary, GPS, NLR, PLR and several nomograms could discriminate patient sub-groups with different survival outcomes or guide therapy choices, but several issues, such as ill-defined cut-off values or a lack of validation, limit their use in clinical practice at the time.…”