title: Validation of a postresection pancreatic adenocarcinoma nomogram for disease-specific survival.
abstract: OBJECTIVE
  Nomograms are statistically based tools that provide the overall probability of a specific outcome. They have shown better individual discrimination than the current TNM staging system in numerous patient tumor models. The pancreatic nomogram combines individual clinicopathologic and operative data to predict disease-specific survival at 1, 2, and 3 years from initial resection. A single US institution database was used to test the validity of the pancreatic adenocarcinoma nomogram established at Memorial Sloan-Kettering Cancer Center.
  
  
  METHODS
  The nomogram was created from a prospective pancreatic adenocarcinoma database that included 555 consecutive patients between October 1983 and April 2000. The nomogram was validated by an external patient cohort from a retrospective pancreatic adenocarcinoma database at Massachusetts General Hospital that included 424 consecutive patients between January 1985 and December 2003.
  
  
  RESULTS
  Of the 424 patients, 375 had all variables documented. At last follow-up, 99 patients were alive, with a median follow-up time of 27 months (range, 2 to 151 months). The 1-, 2-, and 3-year disease-specific survival rates were 68% (95% CI, 63% to 72%), 39% (95% CI, 34% to 44%), and 27% (95% CI, 23% to 32%), respectively. The nomogram concordance index was 0.62 compared with 0.59 with the American Joint Committee on Cancer (AJCC) stage (P = .004). This suggests that the nomogram discriminates disease-specific survival better than the AJCC staging system.
  
  
  CONCLUSIONS
  The pancreatic cancer nomogram provides more accurate survival predictions than the AJCC staging system when applied to an external patient cohort. The nomogram may aid in more accurately counseling patients and in better stratifying patients for clinical trials and molecular tumor analysis.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, Department of Surgery, 1275 York Ave, Box 435, New York, NY 10021, USA. ferronec@mskcc.org
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Ferrone
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: James S
authors.initials: JS
authors.lastname: Tomlinson
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Thayer
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Warshaw
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009367:Neoplasm Staging; D049451:Nomograms; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests