Evaluation of preoperative therapy for pancreatic cancer using a prognostic nomogram

Rebekah R. White, Michael W. Kattan, John C. Haney, Bryan M. Clary, Theodore N. Pappas, Douglas Tyler, Murray F. Brennan

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Theoretical benefits of preoperative chemoradiation therapy (preop CRT) for pancreatic cancer include improved efficacy, resectability, and patient selection. The goal of this study was to evaluate the applicability of a nomogram, which was developed for patients undergoing resection without preop CRT and which incorporates several post-resection pathological factors, to a population of patients who received preop CRT prior to resection. Methods: From 1994 to 2004, 82 patients with biopsy-proven, radiographically localized adenocarcinoma of the pancreatic head underwent preop CRT followed by pancreaticoduodenectomy (PD); 50 concurrent patients underwent PD without preop CRT. Mean nomogram-predicted disease-specific survival (DSS) rates were compared with observed DSS rates from the time of resection. Results: Despite having more locally advanced tumors on initial staging (21 vs. 8%; P < .05), patients who received preop CRT had smaller resected tumors (mean 2.3 vs. 3.1 cm; P < .01), were less likely to have T3 tumors (54 vs. 80%, P < .01), were less likely to have positive lymph nodes (29 vs. 58%, P < .01), and had fewer positive lymph nodes (mean .4 vs. 1.9, P < .01), all factors that imply treatment effect and favorably impact on nomogram-predicted DSS. Observed DSS was similar to predicted DSS in both groups. Conclusions: The similarity in observed and predicted DSS following resection in patients who received preop CRT suggests that the effects of preop CRT-whether treatment, selection, or no effect-are reflected by the nomogram. The ability of the nomogram to evaluate the effects of preop CRT on survival is limited by the potential effects of preop CRT on factors within the nomogram.

Original languageEnglish (US)
Pages (from-to)1485-1492
Number of pages8
JournalAnnals of Surgical Oncology
Volume13
Issue number11
DOIs
StatePublished - Nov 2006
Externally publishedYes

Fingerprint

Nomograms
Pancreatic Neoplasms
Therapeutics
Survival
Pancreaticoduodenectomy
Survival Rate
Lymph Nodes
Neoplasms
Patient Selection
Adenocarcinoma

Keywords

  • Chemoradiation therapy
  • Neoadjuvant therapy
  • Nomogram
  • Pancreatic cancer
  • Preoperative therapy
  • Prognosis

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

White, R. R., Kattan, M. W., Haney, J. C., Clary, B. M., Pappas, T. N., Tyler, D., & Brennan, M. F. (2006). Evaluation of preoperative therapy for pancreatic cancer using a prognostic nomogram. Annals of Surgical Oncology, 13(11), 1485-1492. https://doi.org/10.1245/s10434-006-9104-y

Evaluation of preoperative therapy for pancreatic cancer using a prognostic nomogram. / White, Rebekah R.; Kattan, Michael W.; Haney, John C.; Clary, Bryan M.; Pappas, Theodore N.; Tyler, Douglas; Brennan, Murray F.

In: Annals of Surgical Oncology, Vol. 13, No. 11, 11.2006, p. 1485-1492.

Research output: Contribution to journalArticle

White, RR, Kattan, MW, Haney, JC, Clary, BM, Pappas, TN, Tyler, D & Brennan, MF 2006, 'Evaluation of preoperative therapy for pancreatic cancer using a prognostic nomogram', Annals of Surgical Oncology, vol. 13, no. 11, pp. 1485-1492. https://doi.org/10.1245/s10434-006-9104-y
White, Rebekah R. ; Kattan, Michael W. ; Haney, John C. ; Clary, Bryan M. ; Pappas, Theodore N. ; Tyler, Douglas ; Brennan, Murray F. / Evaluation of preoperative therapy for pancreatic cancer using a prognostic nomogram. In: Annals of Surgical Oncology. 2006 ; Vol. 13, No. 11. pp. 1485-1492.
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abstract = "Background: Theoretical benefits of preoperative chemoradiation therapy (preop CRT) for pancreatic cancer include improved efficacy, resectability, and patient selection. The goal of this study was to evaluate the applicability of a nomogram, which was developed for patients undergoing resection without preop CRT and which incorporates several post-resection pathological factors, to a population of patients who received preop CRT prior to resection. Methods: From 1994 to 2004, 82 patients with biopsy-proven, radiographically localized adenocarcinoma of the pancreatic head underwent preop CRT followed by pancreaticoduodenectomy (PD); 50 concurrent patients underwent PD without preop CRT. Mean nomogram-predicted disease-specific survival (DSS) rates were compared with observed DSS rates from the time of resection. Results: Despite having more locally advanced tumors on initial staging (21 vs. 8{\%}; P < .05), patients who received preop CRT had smaller resected tumors (mean 2.3 vs. 3.1 cm; P < .01), were less likely to have T3 tumors (54 vs. 80{\%}, P < .01), were less likely to have positive lymph nodes (29 vs. 58{\%}, P < .01), and had fewer positive lymph nodes (mean .4 vs. 1.9, P < .01), all factors that imply treatment effect and favorably impact on nomogram-predicted DSS. Observed DSS was similar to predicted DSS in both groups. Conclusions: The similarity in observed and predicted DSS following resection in patients who received preop CRT suggests that the effects of preop CRT-whether treatment, selection, or no effect-are reflected by the nomogram. The ability of the nomogram to evaluate the effects of preop CRT on survival is limited by the potential effects of preop CRT on factors within the nomogram.",
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AU - Haney, John C.

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AU - Pappas, Theodore N.

AU - Tyler, Douglas

AU - Brennan, Murray F.

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N2 - Background: Theoretical benefits of preoperative chemoradiation therapy (preop CRT) for pancreatic cancer include improved efficacy, resectability, and patient selection. The goal of this study was to evaluate the applicability of a nomogram, which was developed for patients undergoing resection without preop CRT and which incorporates several post-resection pathological factors, to a population of patients who received preop CRT prior to resection. Methods: From 1994 to 2004, 82 patients with biopsy-proven, radiographically localized adenocarcinoma of the pancreatic head underwent preop CRT followed by pancreaticoduodenectomy (PD); 50 concurrent patients underwent PD without preop CRT. Mean nomogram-predicted disease-specific survival (DSS) rates were compared with observed DSS rates from the time of resection. Results: Despite having more locally advanced tumors on initial staging (21 vs. 8%; P < .05), patients who received preop CRT had smaller resected tumors (mean 2.3 vs. 3.1 cm; P < .01), were less likely to have T3 tumors (54 vs. 80%, P < .01), were less likely to have positive lymph nodes (29 vs. 58%, P < .01), and had fewer positive lymph nodes (mean .4 vs. 1.9, P < .01), all factors that imply treatment effect and favorably impact on nomogram-predicted DSS. Observed DSS was similar to predicted DSS in both groups. Conclusions: The similarity in observed and predicted DSS following resection in patients who received preop CRT suggests that the effects of preop CRT-whether treatment, selection, or no effect-are reflected by the nomogram. The ability of the nomogram to evaluate the effects of preop CRT on survival is limited by the potential effects of preop CRT on factors within the nomogram.

AB - Background: Theoretical benefits of preoperative chemoradiation therapy (preop CRT) for pancreatic cancer include improved efficacy, resectability, and patient selection. The goal of this study was to evaluate the applicability of a nomogram, which was developed for patients undergoing resection without preop CRT and which incorporates several post-resection pathological factors, to a population of patients who received preop CRT prior to resection. Methods: From 1994 to 2004, 82 patients with biopsy-proven, radiographically localized adenocarcinoma of the pancreatic head underwent preop CRT followed by pancreaticoduodenectomy (PD); 50 concurrent patients underwent PD without preop CRT. Mean nomogram-predicted disease-specific survival (DSS) rates were compared with observed DSS rates from the time of resection. Results: Despite having more locally advanced tumors on initial staging (21 vs. 8%; P < .05), patients who received preop CRT had smaller resected tumors (mean 2.3 vs. 3.1 cm; P < .01), were less likely to have T3 tumors (54 vs. 80%, P < .01), were less likely to have positive lymph nodes (29 vs. 58%, P < .01), and had fewer positive lymph nodes (mean .4 vs. 1.9, P < .01), all factors that imply treatment effect and favorably impact on nomogram-predicted DSS. Observed DSS was similar to predicted DSS in both groups. Conclusions: The similarity in observed and predicted DSS following resection in patients who received preop CRT suggests that the effects of preop CRT-whether treatment, selection, or no effect-are reflected by the nomogram. The ability of the nomogram to evaluate the effects of preop CRT on survival is limited by the potential effects of preop CRT on factors within the nomogram.

KW - Chemoradiation therapy

KW - Neoadjuvant therapy

KW - Nomogram

KW - Pancreatic cancer

KW - Preoperative therapy

KW - Prognosis

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