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Authors He C, Zhong L, Zhang Y, Cai Z, Lin X
Received 7 January 2019
Accepted for publication 29 March 2019
Published 2 May 2019 Volume 2019:11 Pages 3981—3991
DOI https://doi.org/10.2147/CMAR.S200684
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 4
Editor who approved publication: Dr Ahmet Emre Eskazan
Background: Few
studies have explored the relationship between clinicopathological factors of
patients with pancreatic ductal adenocarcinoma (PDAC) and liver metastasis. The
aim of this study was to develop and validate a nomogram to predict liver
metastasis in patients with PDAC.
Patients and methods: Patients
diagnosed with PDAC between 2004 and 2015 from the Surveillance, Epidemiology,
and End Results (SEER) database were retrospectively collected. The nomogram
was established based on a logistic regression model. The precision of the
nomogram was evaluated and compared using concordance index (C-index), and the
area under receiver operating characteristic curve (AUC). The clinical use of
nomogram was evaluated by making use of a decision curve analysis (DCA).
Results: A total
of 12,644 eligible patients, which were randomly divided into training
(n=9,483) and validation cohorts (n=3,161), were included in this study. The
nomograms, which were established on the basis of independent predictors, were
well calibrated, and demonstrated good discriminative ability, with C-indexes
of 0.784 for the training cohort and 0.790 for validation cohort. The values of
AUC for training and validation cohort were 0.792 and 0.800, respectively. When
other sites of distant metastases were included into this predictive system,
the new predictive model demonstrated a better discriminative ability and
greater net benefit in predicting liver metastasis in patients with PDAC in
both the training and validation cohorts.
Conclusion: Nomograms
were constructed to predict liver metastasis in patients with PDAC. Validation
revealed excellent discrimination and calibration of the nomograms, suggesting
that the nomograms were well calibrated and could serve to improve the
prediction of the risks of liver metastasis which can be used to guide the management
of patients with PDAC.
Keywords: pancreatic
ductal adenocarcinoma, liver metastasis, predictor, nomogram, SEER