title: A nomogram based on preoperative inflammatory markers predicting the overall survival of pancreatic ductal adenocarcinoma.
abstract: OBJECTIVE
  Developing a preoperative prediction model for estimating the risk of pancreatic ductal adenocarcinoma (PDAC) patients before pancreaticoduodenectomy is a difficult task. The purpose of current study was to develop a prognostic nomogram based on inflammatory markers for PDAC patients.
  
  
  METHODS
  Cox regression analysis was performed to calculate the overall survival (OS) and assess the prognostic factors based on 265 PDAC patients undergone surgery. The nomogram was built to estimate the probability of 1-year, 3-year, and 5-year OS. The predictive accuracy of nomogram was determined by concordance index, calibration curve, and time dependent receiver operating characteristics.
  
  
  RESULTS
  In multivariable Cox analysis, vascular invasion, Tumor Grade, TNM stage, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and albumin/globulin ratio were significantly associated with OS, which were all assembled into nomogram. The calibration curves for probability of survival showed optimal agreement between nomogram prediction and actual observation. The concordance index for 1-year, 3-year and 5-year OS prediction were 0.860 (95% confidence intervals (CI): 0.837-0.885), 0.837 (95%CI: 0.819-0.856), and 0.809 (95%CI: 0.787-0.829), respectively. The area under time dependent receiver operating characteristics curve of 1-year, 3-year, and 5-year OS prediction were 0.938 (95%CI: 0.886-0.989), 0.844 (95%CI: 0.782-0.906), and 0.884 (95%CI: 0.792-0.976), suggesting high discriminative ability of nomogram. It allowed significant distinction survival outcomes by grouping the patients evenly into three subgroups after sorting by total points.
  
  
  CONCLUSIONS
  Based on clinicopathology characteristics and inflammatory markers, we developed a nomogram providing an individualized risk estimate for PDAC patients.
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Ke-Qing
authors.identifier: http://orcid.org/0000-0002-5070-3834
authors.initials: KQ
authors.lastname: Shi
authors.affiliation: Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Bi-Cheng
authors.initials: BC
authors.lastname: Chen
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Zhi-Peng
authors.initials: ZP
authors.lastname: Huang
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Fei-Yu
authors.initials: FY
authors.lastname: Lu
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Meng-Tao
authors.initials: MT
authors.lastname: Zhou
mesh_terms: D000328:Adult; D015415:Biomarkers; D001772:Blood Cell Count; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D049451:Nomograms; D010190:Pancreatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors
chemical_list: D015415:Biomarkers
keywords: inflammatory markers; nomogram; overall survival; pancreatic ductal adenocarcinoma