Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2019; 11(11): 1043-1053
Published online Nov 15, 2019. doi: 10.4251/wjgo.v11.i11.1043
Validation and head-to-head comparison of four models for predicting malignancy of intraductal papillary mucinous neoplasm of the pancreas: A study based on endoscopic ultrasound findings
Jie Hua, Bo Zhang, Xiu-Jiang Yang, Yi-Yin Zhang, Miao-Yan Wei, Chen Liang, Qing-Cai Meng, Jiang Liu, Xian-Jun Yu, Jin Xu, Si Shi
Jie Hua, Bo Zhang, Yi-Yin Zhang, Miao-Yan Wei, Chen Liang, Qing-Cai Meng, Jiang Liu, Xian-Jun Yu, Jin Xu, Si Shi, Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Fudan University Shanghai Medical College, Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
Xiu-Jiang Yang, Department of Endoscopy, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Author contributions: Hua J, Yang XJ, Yu XJ, and Shi S conceived and designed the study; Hua J, Zhang YY, Wei MY, Liang C, Meng QC, and Liu J acquired and analyzed the data; Hua J, Zhang B, Zhang YY, and Liang C performed statistical analysis; Hua J, Zhang B, Wei MY, and Meng QC drafted the manuscript; Yang XJ, Yu XJ, Xu J, and Shi S critically revised the manuscript; Yu XJ, Xu J, and Shi S provided funding support; Yang XJ, Yu XJ, Xu J, and Shi S supervised the study.
Supported by The China National Funds for Distinguished Young Scientists, No. 81625016; The National Natural Science Foundation of China, No. 81772555; The Science and Technology Commission of Shanghai Municipality, No. 17YF1402500.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Fudan University Shanghai Cancer Center.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Si Shi, MD, Attending Doctor, Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong’an Road, Xuhui District, Shanghai 200032, China. shisi@fudanpci.org
Telephone: +86-21-64175590 Fax: +86-21-64031446
Received: May 22, 2019
Peer-review started: May 23, 2019
First decision: July 31, 2019
Revised: September 6, 2019
Accepted: September 13, 2019
Article in press: September 13, 2019
Published online: November 15, 2019
ARTICLE HIGHLIGHTS
Research background

Intraductal papillary mucinous neoplasm (IPMN) has the potential to become malignant. Thus, preoperative prediction of its malignancy is of vital importance to clinical practice. Currently, several models are available for predicting the malignancy of IPMN. However, whether these models can be widely applied in clinical practice remains unknown. This study aimed to externally validate these models and compare their accuracy in predicting the individualized probability of malignancy in patients with IPMN. The results may aid clinicians in assessing an individual’s risk for malignant IPMN.

Research motivation

To better facilitate clinicians’ evaluation of a patient’s risk–benefit profile for IPMN resection vs surveillance.

Research objectives

The aim of this study was to perform a head-to-head comparison of four models for predicting the malignancy of IPMN. The results may provide a reference for clinicians when evaluating the malignant potential of IPMN.

Research methods

Data of 181 patients with available preoperative endoscopic ultrasound records and pathologically confirmed IPMN were collected from a prospectively maintained institutional database over a 9-year period. Model comparison was assessed by using concordance index (C-index), calibration plots, decision curve analyses, and diagnostic tests.

Research results

The C-index of the model from the Pancreatic Surgery Consortium (PSC) was 0.842 [95% confidence interval (CI): 0.782-0.901], which was the highest among the four examined models. Calibration plots showed that the PSC model had the least pronounced departure from ideal predictions. In the decision curve analyses, the PSC model showed a better clinical net benefit than the three other models. Diagnostic tests also showed that the PSC model had the highest accuracy (0.801).

Research conclusions

The PSC model showed the best performance characteristics. Therefore, the PSC model should be considered the best tool for assessing an individual’s risk for malignant IPMN and may facilitate clinical decision-making regarding resection vs surveillance.

Research perspectives

Future studies should focus on integrating CA19-9 into the PSC model and develop reliable biomarkers for predicting IPMN malignancy.