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Oncol."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study aimed to develop and externally validate a nomogram for predicting liver metastasis after radical resection in patients with pancreatic ductal adenocarcinoma (PDAC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 247 PDAC patients who underwent radical resection were retrospectively reviewed from January 2015 to March 2022 at Ningbo Medical Centre Lihuili Hospital Eastern Section, and used as a training cohort to develop the nomogram. 83 PDAC patients from the Ningbo Medical Centre Lihuili Hospital Xingning Section were enrolled as the validation cohort. The postoperative liver metastasis was recorded during the follow-up, and the liver metastasis-free survival was defined as the time from operation to the date of liver metastasis diagnosis or death. The nomogram was established based on independent prognostic factors selected by LASSO and multivariate Cox regression model. The performance was assessed using the concordance index (C-index) and calibration curves. The receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to determine the clinical utility of the nomogram model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From the training cohort of 247 patients, a total of 132 patients developed liver metastasis during the follow-up, the 1-, 2- and 3- year liver metastasis-free survival were 52.4%, 43.5% and 40% respectively. The LASSO and multivariate Cox regression analysis indicated that postoperative CA125 (hazard ratio [HR] = 1.007, <jats:italic>p &amp;lt;<\/jats:italic>0.001), tumor differentiation (HR = 1.640, <jats:italic>p<\/jats:italic> = 0.010), tumor size (HR = 1.520, <jats:italic>p<\/jats:italic> = 0.029), lymph node ratio (HR = 1.897, <jats:italic>p<\/jats:italic> = 0.002) and portal\/superior mesenteric\/splenic vein invasion degree (PV\/SMV\/SV) (HR = 2.829, <jats:italic>p &amp;lt;<\/jats:italic>0.001) were the independent factors of liver metastasis. A nomogram with independent factors was developed and the C-index was 0.760 (95% confidence interval [CI], 0.720-0.799) and 0.739 (95% CI, 0.669-0.810) in the training and validation cohorts, respectively. The areas under curve (AUC) of the nomogram at 1-, 2- and 3-year were 0.815, 0.803 and 0.773 in the training cohort, and 0.765, 0.879 and 0.908 in the validation cohort, respectively, higher than those in TNM stage. Decision curve analysis (DCA) analysis revealed that the nomogram model provided superior net benefit in clinical utility. Liver metastasis-free survival curves showed a significant discriminatory ability for liver metastasis risk based on the nomogram (<jats:italic>p &amp;lt;<\/jats:italic>0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The nomogram showed high accuracy in predicting liver metastasis for PDAC after radical resection, and may serve as a clinical support tool to guide personalized and prescient intervention.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2022.1040411","type":"journal-article","created":{"date-parts":[[2022,11,21]],"date-time":"2022-11-21T07:07:21Z","timestamp":1669014441000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Development and validation of a nomogram to predict liver metastasis for pancreatic ductal adenocarcinoma after radical resection"],"prefix":"10.3389","volume":"12","author":[{"given":"Jingshu","family":"Tong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuqi","family":"Mao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengdong","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caide","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,11,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2020.10.007","article-title":"Worldwide burden of, risk factors for, and trends in pancreatic cancer","volume":"160","author":"Huang","year":"2021","journal-title":"Gastroenterology"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2012.05.020","article-title":"Pancreatic ductal adenocarcinoma: Long-term survival does not equal cure","volume":"152","author":"Ferrone","year":"2012","journal-title":"Surgery"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.hbpd.2020.12.006","article-title":"Long-term survival after pancreaticoduodenectomy in patients with ductal adenocarcinoma of the pancreatic head","volume":"20","author":"Luu","year":"2021","journal-title":"Hepatobiliary Pancreat Dis Int"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-018-6558-7","article-title":"Implications of the pattern of disease recurrence on survival following pancreatectomy for pancreatic ductal adenocarcinoma","volume":"25","author":"Groot","year":"2018","journal-title":"Ann Surg Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002234","article-title":"Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma","volume":"267","author":"Groot","year":"2018","journal-title":"Ann Surg"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/8061879","article-title":"Risk factors of early liver metastasis for pancreatic ductal adenocarcinoma after radical resection","volume":"2022","author":"Tong","year":"2022","journal-title":"Gastroenterol Res Pract"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.682969","article-title":"Development and validation of a nomogram based on nutritional indicators and tumor markers for prognosis prediction of pancreatic ductal adenocarcinoma","volume":"11","author":"Li","year":"2021","journal-title":"Front Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.734673","article-title":"Development and validation of a nomogram to predict survival in pancreatic head ductal adenocarcinoma after pancreaticoduodenectomy","volume":"11","author":"Peng","year":"2021","journal-title":"Front Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2012.0073","article-title":"Pancreatic adenocarcinoma, version 2.2012: Featured updates to the NCCN guidelines","volume":"10","author":"Tempero","year":"2012","journal-title":"J Natl Compr Canc Netw"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.3617","article-title":"International validation of the eighth edition of the American joint committee on cancer (AJCC) TNM staging system in patients with resected pancreatic cancer","volume":"153","author":"van Roessel","year":"2018","journal-title":"JAMA Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1097\/MPA.0000000000000816","article-title":"Clinical practice guidelines for pancreatic cancer 2016 from the Japan pancreas society: A synopsis","volume":"46","author":"Yamaguchi","year":"2017","journal-title":"Pancreas"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1021\/bi00821a013","article-title":"Collagen structure in solution. 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