Validation of a prognostic nomogram in patients undergoing resection for pancreatic ductal adenocarcinoma in a UK tertiary referral centre

AbstractIntroduction. Survival following resection for pancreatic ductal adenocarcinoma (PDAC) remains poor. The aim of this study was to validate a survival nomogram designed at the Memorial Sloan-Kettering Cancer Centre (MSKCC) in a UK tertiary referral centre. Methods. Patients who underwent resection for PDAC between 1995 and 2005 were analysed retrospectively. Standard prognostic factors and nomogram-specific data were collected. Continuous data are presented as median (inter-quartile range). Results. Sixty-three patients were analysed. The median survival was 326 (209–680) days. On univariate analysis lymph node status (node +ve 297 (194–471) days versus node −ve 367 (308–1060) days, p=0.005) and posterior margin involvement (margin +ve 210 (146–443) days versus margin −ve 355 (265–835) days, p=0.024) were predictors of a poor survival. Only lymph node positivity was significant on multivariate analysis (p=0.006). The median nomogram score was 217 (198–236). A nomogram score of 113–217 predicted a median survival of 367 (295–847) days compared to 265 (157–443) days for a score of 218–269, p=0.012. Conclusion. Increasing nomogram score was associated with poorer survival. However the accuracy demonstrated by MSKCC could not be replicated in the current cohort of patients and may reflect differences in patient demographics, accuracy of pathological staging and differences in treatment regimens between the two centres