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Modeling prognostic factors in resectable pancreatic adenocarcinomas.

Botsis T, Anagnostou VK, Hartvigsen G, Hripcsak G, Weng C - Cancer Inform (2010)

Bottom Line: Age, tumor differentiation and size, alkaline phosphatase, albumin and CA 19-9 were the independent factors of the final multivariable model; patients were thus classified into low (n = 14, median survival = 53.7 months), intermediate (n = 124, median survival = 19.7 months) and high risk groups (n = 80, median survival = 12.3 months).The prognostic classification of our model remained significant after adjusting for adjuvant chemotherapy and the concordance index was 0.73 compared to 0.59 of the TNM system.Our prognostic model was accurate in stratifying patients by risk and could be incorporated into clinical decisions.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Informatics, Columbia University, 10032 New York, USA.

ABSTRACT

Background: The accurate prognosis for patients with resectable pancreatic adenocarcinomas requires the incorporation of more factors than those included in AJCC TNM system.

Methods: We identified 218 patients diagnosed with stage I and II pancreatic adenocarcinoma at NewYork-Presbyterian Hospital/Columbia University Medical Center (1999 to 2009). Tumor and clinical characteristics were retrieved and associations with survival were assessed by univariate Cox analysis. A multivariable model was constructed and a prognostic score was calculated; the prognostic strength of our model was assessed with the concordance index.

Results: Our cohort had a median age of 67 years and consisted of 49% men; the median follow-up time was 14.3 months and the 5-year survival 3.6%. Age, tumor differentiation and size, alkaline phosphatase, albumin and CA 19-9 were the independent factors of the final multivariable model; patients were thus classified into low (n = 14, median survival = 53.7 months), intermediate (n = 124, median survival = 19.7 months) and high risk groups (n = 80, median survival = 12.3 months). The prognostic classification of our model remained significant after adjusting for adjuvant chemotherapy and the concordance index was 0.73 compared to 0.59 of the TNM system.

Conclusion: Our prognostic model was accurate in stratifying patients by risk and could be incorporated into clinical decisions.

No MeSH data available.


Related in: MedlinePlus

Disease outcome by A) our multivariable model with low risk patients showing an exceptional benefit towards survival compared to intermediate (log rank p = 0.005) and high risk patients (log rank p < 0.001); intermediate vs. high risk patients also have better outcome (log rank p < 0.001) and B) the AJCC TNM staging system (log rank p(IA vs. IB) = 0.125, p(IA vs. IIA) = 0.056, p(IA vs. IIB)= 0.010, p(IB vs. IIA) = 0.718, p(IB vs. IIB) = 0.315 and p(IIA vs. IIB) = 0.311).
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f1-cin-2009-281: Disease outcome by A) our multivariable model with low risk patients showing an exceptional benefit towards survival compared to intermediate (log rank p = 0.005) and high risk patients (log rank p < 0.001); intermediate vs. high risk patients also have better outcome (log rank p < 0.001) and B) the AJCC TNM staging system (log rank p(IA vs. IB) = 0.125, p(IA vs. IIA) = 0.056, p(IA vs. IIB)= 0.010, p(IB vs. IIA) = 0.718, p(IB vs. IIB) = 0.315 and p(IIA vs. IIB) = 0.311).

Mentions: Patients in the low risk group had a better prognosis compared to patients in the intermediate (median survival 53.7 vs. 19.7 months, p = 0.005; Fig. 1A) and high risk group (median survival 53.7 vs. 12.3 months, p < 0.001; Fig. 1A). Patients classified in the intermediate risk group showed a distinct benefit towards overall survival compared to patients of the high risk group (median survival 19.7 vs. 12.3 months, p < 0.001; Fig. 1A). Interestingly 4 and 7 patients with IIA and IIB TNM disease respectively were classified in the low risk group whereas 7 stage IB patients were classified in the high risk group, underlying the weakness of the AJCC TNM system to accurately stratify patients by risk based on the tumor characteristics only (survival curves for AJCC TNM stages are shown in Fig. 1B). The concordance index calculated to assess the accuracy of our model was equal to 0.73 (95% CI: 0.58–0.84). The concordance index of the TNM staging system was equal to 0.59 (95% CI: 0.42–0.74) when patients were grouped into stages IA, IB, IIA and IIB and 0.62 (95% CI: 0.38–0.81) when they were classified into stages I and II.


Modeling prognostic factors in resectable pancreatic adenocarcinomas.

Botsis T, Anagnostou VK, Hartvigsen G, Hripcsak G, Weng C - Cancer Inform (2010)

Disease outcome by A) our multivariable model with low risk patients showing an exceptional benefit towards survival compared to intermediate (log rank p = 0.005) and high risk patients (log rank p < 0.001); intermediate vs. high risk patients also have better outcome (log rank p < 0.001) and B) the AJCC TNM staging system (log rank p(IA vs. IB) = 0.125, p(IA vs. IIA) = 0.056, p(IA vs. IIB)= 0.010, p(IB vs. IIA) = 0.718, p(IB vs. IIB) = 0.315 and p(IIA vs. IIB) = 0.311).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2865167&req=5

f1-cin-2009-281: Disease outcome by A) our multivariable model with low risk patients showing an exceptional benefit towards survival compared to intermediate (log rank p = 0.005) and high risk patients (log rank p < 0.001); intermediate vs. high risk patients also have better outcome (log rank p < 0.001) and B) the AJCC TNM staging system (log rank p(IA vs. IB) = 0.125, p(IA vs. IIA) = 0.056, p(IA vs. IIB)= 0.010, p(IB vs. IIA) = 0.718, p(IB vs. IIB) = 0.315 and p(IIA vs. IIB) = 0.311).
Mentions: Patients in the low risk group had a better prognosis compared to patients in the intermediate (median survival 53.7 vs. 19.7 months, p = 0.005; Fig. 1A) and high risk group (median survival 53.7 vs. 12.3 months, p < 0.001; Fig. 1A). Patients classified in the intermediate risk group showed a distinct benefit towards overall survival compared to patients of the high risk group (median survival 19.7 vs. 12.3 months, p < 0.001; Fig. 1A). Interestingly 4 and 7 patients with IIA and IIB TNM disease respectively were classified in the low risk group whereas 7 stage IB patients were classified in the high risk group, underlying the weakness of the AJCC TNM system to accurately stratify patients by risk based on the tumor characteristics only (survival curves for AJCC TNM stages are shown in Fig. 1B). The concordance index calculated to assess the accuracy of our model was equal to 0.73 (95% CI: 0.58–0.84). The concordance index of the TNM staging system was equal to 0.59 (95% CI: 0.42–0.74) when patients were grouped into stages IA, IB, IIA and IIB and 0.62 (95% CI: 0.38–0.81) when they were classified into stages I and II.

Bottom Line: Age, tumor differentiation and size, alkaline phosphatase, albumin and CA 19-9 were the independent factors of the final multivariable model; patients were thus classified into low (n = 14, median survival = 53.7 months), intermediate (n = 124, median survival = 19.7 months) and high risk groups (n = 80, median survival = 12.3 months).The prognostic classification of our model remained significant after adjusting for adjuvant chemotherapy and the concordance index was 0.73 compared to 0.59 of the TNM system.Our prognostic model was accurate in stratifying patients by risk and could be incorporated into clinical decisions.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Informatics, Columbia University, 10032 New York, USA.

ABSTRACT

Background: The accurate prognosis for patients with resectable pancreatic adenocarcinomas requires the incorporation of more factors than those included in AJCC TNM system.

Methods: We identified 218 patients diagnosed with stage I and II pancreatic adenocarcinoma at NewYork-Presbyterian Hospital/Columbia University Medical Center (1999 to 2009). Tumor and clinical characteristics were retrieved and associations with survival were assessed by univariate Cox analysis. A multivariable model was constructed and a prognostic score was calculated; the prognostic strength of our model was assessed with the concordance index.

Results: Our cohort had a median age of 67 years and consisted of 49% men; the median follow-up time was 14.3 months and the 5-year survival 3.6%. Age, tumor differentiation and size, alkaline phosphatase, albumin and CA 19-9 were the independent factors of the final multivariable model; patients were thus classified into low (n = 14, median survival = 53.7 months), intermediate (n = 124, median survival = 19.7 months) and high risk groups (n = 80, median survival = 12.3 months). The prognostic classification of our model remained significant after adjusting for adjuvant chemotherapy and the concordance index was 0.73 compared to 0.59 of the TNM system.

Conclusion: Our prognostic model was accurate in stratifying patients by risk and could be incorporated into clinical decisions.

No MeSH data available.


Related in: MedlinePlus