A hierarchical prognostic model for Co-diabetes pancreatic adenocarcinoma

Zelong Wu; Chunsheng Liu; Zuyi Ma; Zhenchong Li; Shujie Wang; Yubin Chen; Mingqian Han; Shanzhou Huang; Qi Zhou; Chuanzhao Zhang; Baohua Hou

doi:10.1016/j.heliyon.2023.e21642

A hierarchical prognostic model for Co-diabetes pancreatic adenocarcinoma

Heliyon. 2023 Nov 4;9(11):e21642. doi: 10.1016/j.heliyon.2023.e21642. eCollection 2023 Nov.

Authors

Zelong Wu^{1

2

3}, Chunsheng Liu^{1

2

3}, Zuyi Ma⁴, Zhenchong Li⁵, Shujie Wang^{1

3}, Yubin Chen^{1

3

6}, Mingqian Han^{1

2

3}, Shanzhou Huang^{1

2

3

6}, Qi Zhou^{7

8}, Chuanzhao Zhang^{1

2

3

6}, Baohua Hou^{1

2

3

6}

Affiliations

¹ The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China.
² Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
³ Heyuan People's Hospital, Heyuan 517000, China.
⁴ Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100005, China.
⁵ German Cancer Research Center (DKFZ), Junior Clinical Cooperation Unit Translational Gastrointestinal Oncology and Preclinical Models, Heidelberg, Germany.
⁶ South China University of Technology School of Medicine, Guangzhou 51000, China.
⁷ Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.
⁸ Department of General Surgery, Hui Ya Hospital of the First Affiliated Hospital, Sun Yat-sen University, Huizhou, Guangdong 516081, China.

Abstract

Background: Co-diabetes pancreatic adenocarcinoma has a poorer prognosis than pancreatic adenocarcinoma without diabetes. This study aimed to develop a reliable prognostic model for patients with co-diabetes pancreatic adenocarcinoma.

Method: Overall, 169 patients with co-diabetes pancreatic adenocarcinoma were included in our study. First, the independent risk factors affecting the prognosis of patients with co-diabetes pancreatic adenocarcinoma were determined by univariate and multivariate Cox regression analyses. Based on these identified risk factors, we developed a nomogram and evaluated its predictive ability using the concordance index, receiver operating characteristic curve, calibration plot, decision curve, and net reclassification index.

Results: In this study, prealbumin, transferrin, carcinoembryonic antigen, distant metastasis, tumor differentiation neutrophil count, lymphocyte count and fasting blood glucose were confirmed as significant prognostic factors. Based on these predictors, a new nomogram was developed. Compared with the American Joint Committee on Cancer 8 staging system and other models, the nomogram achieved a higher concordance index in the training (0.795) and validation (0.729) queues. The area under the nomogram's curve for predicting patient survival at 0.5, 1, and 1.5 years in the training queue was >0.8. Patients were risk-stratified using the nomogram, and Kaplan-Meier survival curves of subgroups were plotted. The Kaplan-Meier curve also showed better separation than the American Joint Committee on Cancer 8 staging system, indicating that our model has a better risk hierarchical ability.

Conclusions: Compared to the American Joint Committee on Cancer 8 staging system and other predictive models, our model showed better predictive ability for patients with co-diabetes pancreatic adenocarcinoma. Our model will help in patients' risk stratification and improves their prognosis.

Keywords: Co-diabetes pancreatic adenocarcinoma; Nomogram; Overall survival; Prealbumin; Prognostic hierarchical; Transferrin.