Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2023; 15(1): 128-142
Published online Jan 15, 2023. doi: 10.4251/wjgo.v15.i1.128
Risk factors, prognostic predictors, and nomograms for pancreatic cancer patients with initially diagnosed synchronous liver metastasis
Bi-Yang Cao, Fang Tong, Le-Tian Zhang, Yi-Xin Kang, Chen-Chen Wu, Qian-Qian Wang, Wei Yang, Jing Wang
Bi-Yang Cao, Fang Tong, Le-Tian Zhang, Yi-Xin Kang, Chen-Chen Wu, Qian-Qian Wang, Wei Yang, Jing Wang, Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Bi-Yang Cao, Le-Tian Zhang, Yi-Xin Kang, Chen-Chen Wu, Medical School of Chinese PLA, Beijing 100853, China
Author contributions: Cao BY and Tong F contributed equally to this work; Cao BY and Tong F designed the research and wrote the first manuscript; Zhang LT, Kang YX, Wu CC, and Wang QQ contributed to conceiving the research and analyzing the data; Yang W and Wang J conducted the analysis and provided guidance for the research, and they were co-corresponding authors, and all authors reviewed and approved the final manuscript.
Institutional review board statement: Our research is based on the National Cancer Institute’s SEER program. For this study, we signed the SEER research data agreement to access SEER information, using reference number 15159-Nov2020. Data were obtained following the approved guidelines. The Office for Human Research Protection considered this research to be on nonhuman subjects because the subjects were patients who had been researched by the United States Department of Health and Human Services and were publicly accessible and de-dentified. Thus, no institutional review board approval was required.
Informed consent statement: Patients were not required to provide informed consent to the study because this study used a public database with anonymous clinical data, and the patients’ personal privacy information was not available.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Data sharing statement: The dataset from SEER database analyzed during the current study are available in the SEER dataset repository (https://seer.cancer.gov/).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Yang, PhD, Professor, Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. yangwei1437@163.com
Received: November 2, 2022
Peer-review started: November 2, 2022
First decision: November 14, 2022
Revised: November 17, 2022
Accepted: December 7, 2022
Article in press: December 7, 2022
Published online: January 15, 2023
Abstract
BACKGROUND

Liver metastasis (LM) remains a major cause of cancer-related death in patients with pancreatic cancer (PC) and is associated with a poor prognosis. Therefore, identifying the risk and prognostic factors in PC patients with LM (PCLM) is essential as it may aid in providing timely medical interventions to improve the prognosis of these patients. However, there are limited data on risk and prognostic factors in PCLM patients.

AIM

To investigate the risk and prognostic factors of PCLM and develop corresponding diagnostic and prognostic nomograms.

METHODS

Patients with primary PC diagnosed between 2010 and 2015 were reviewed from the Surveillance, Epidemiology, and Results Database. Risk factors were identified using multivariate logistic regression analysis to develop the diagnostic mode. The least absolute shrinkage and selection operator Cox regression model was used to determine the prognostic factors needed to develop the prognostic model. The performance of the two nomogram models was evaluated using receiver operating characteristic (ROC) curves, calibration plots, decision curve analysis (DCA), and risk subgroup classification. The Kaplan-Meier method with a log-rank test was used for survival analysis.

RESULTS

We enrolled 33459 patients with PC in this study. Of them, 11458 (34.2%) patients had LM at initial diagnosis. Age at diagnosis, primary site, lymph node metastasis, pathological type, tumor size, and pathological grade were identified as independent risk factors for LM in patients with PC. Age > 70 years, adenocarcinoma, poor or anaplastic differentiation, lung metastases, no surgery, and no chemotherapy were the independently associated risk factors for poor prognosis in patients with PCLM. The C- index of diagnostic and prognostic nomograms were 0.731 and 0.753, respectively. The two nomograms could accurately predict the occurrence and prognosis of patients with PCLM based on the observed analysis results of ROC curves, calibration plots, and DCA curves. The prognostic nomogram could stratify patients into prognostic groups and perform well in internal validation.

CONCLUSION

Our study identified the risk and prognostic factors in patients with PCLM and developed corresponding diagnostic and prognostic nomograms to help clinicians in subsequent clinical evaluation and intervention. External validation is required to confirm these results.

Keywords: Pancreatic neoplasms, Neoplasm metastasis, Liver, Prognosis, Nomograms, Surveillance, Epidemiology, and End Result program

Core Tip: Pancreatic cancer (PC) has a poor prognosis owing to its risk of metastasis. The risk and prognostic factors for patients with distant metastasis at diagnosis have been studied; however, few studies have focused on liver metastasis (LM), the most common target organ. This study investigated the risk and prognostic factors for PC patients with LM at diagnosis using the Surveillance, Epidemiology, and End Results database on a population-based level and developed two nomograms for predicting the risk and prognosis for these patients. The nomograms developed in this study can be a convenient tool for facilitating clinical decision-making.