{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T15:07:07Z","timestamp":1764688027895,"version":"3.41.2"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T00:00:00Z","timestamp":1674604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Pancreatic cancer is one of the most malignant cancers worldwide, and it mostly occurs in the head of the pancreas. Existing laparoscopic pancreaticoduodenectomy (LPD) surgical techniques have has undergone a learning curve, a wide variety of approaches for the treatment of pancreatic cancer have been proposed, and the operation has matured. At present, pancreatic head cancer has been gradually changing from \u201csurgeons\u2019 evaluation of anatomical resection\u201d to \u201cbiologically inappropriate resection\u201d. In this study, the risk of lymph node metastasis in pancreatic head cancer was predicted using common preoperative clinical indicators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The preoperative clinical data of 191 patients with pancreatic head cancer who received LPD in the First Affiliated Hospital of Jilin University from May 2016 to December 2021 were obtained. A univariate regression analysis study was conducted, and the indicators with a significance level of P&amp;lt;0.05 were included in the univariate logistic regression analysis into multivariate. Lastly, a nomogram was built based on age, tumor size, leucocyte,albumin(ALB), and lymphocytes\/monocytes(LMR). The model with the highest resolution was selected by obtaining the area under a curve. The clinical net benefit of the prediction model was examined using decision curve analyses.Risk stratification was performed by combining preoperative CT scan with existing models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Multivariate logistic regression analysis found age, tumor size, WBC, ALB, and LMR as five independent factors. A nomogram model was constructed based on the above indicators. The model was calibrated by validating the calibration curve within 1000 bootstrap resamples. The ROC curve achieved an AUC of 0.745(confidence interval of 95%: 0.673-0.816), thus indicating that the model had excellent discriminative skills. DCA suggested that the predictive model achieved a high net benefit in the nearly entire threshold probability range.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study has been the first to investigate a nomogram for preoperative prediction of lymphatic metastasis in pancreatic head cancer. The result suggests that age, ALB, tumor size, WBC, and LMR are independent risk factors for lymph node metastasis in pancreatic head cancer. This study may provide a novel perspective for the selection of appropriate continuous treatment regimens, the increase of the survival rate of patients with pancreatic head cancer, and the selection of appropriate neoadjuvant therapy patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2023.1053375","type":"journal-article","created":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T06:27:36Z","timestamp":1674628056000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["New nomogram for predicting lymph node positivity in pancreatic head cancer"],"prefix":"10.3389","volume":"13","author":[{"given":"Xingren","family":"Guo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiangyang","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyin","family":"Long","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yahui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yixin","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bai","family":"Ji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.21654","article-title":"Cancer statistics, 2021","volume":"71","author":"Siegel","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.610","article-title":"A multidisciplinary approach to pancreas cancer in 2016: A review","volume":"112","author":"Fogel","year":"2017","journal-title":"Am J Gastroenterol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-008-0295-2","article-title":"Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma","volume":"16","author":"Katz","year":"2009","journal-title":"Ann Surg Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2017.05.007","article-title":"Has survival improved following resection for pancreatic adenocarcinoma","volume":"214","author":"Luberice","year":"2017","journal-title":"Am J Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2021.0017","article-title":"Pancreatic adenocarcinoma, version 2.2021, nccn clinical practice guidelines in oncology","volume":"19","author":"Tempero","year":"2021","journal-title":"J Natl Compr Cancer Network"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.12.029","article-title":"Implications of inaccurate clinical nodal staging in pancreatic adenocarcinoma","volume":"162","author":"Swords","year":"2017","journal-title":"Surgery"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1306774","article-title":"Lymph node characterization in vivo using endoscopic ultrasound spectrum analysis with electronic array echo endoscopes","volume":"44","author":"Kumon","year":"2012","journal-title":"Endoscopy"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-010-1180-y","article-title":"Preoperative diagnosis of lymph node metastasis in biliary and pancreatic carcinomas: Evaluation of the combination of multi-detector ct and serum Ca19-9 level","volume":"55","author":"Nanashima","year":"2010","journal-title":"Digestive Dis Sci"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jim.2013.06.013","article-title":"High resolution mri for non-invasive mouse lymph node mapping","author":"Zhang","year":"2013","journal-title":"J Immunol Methods"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-019-02248-0","article-title":"The value of (18)F-fdg Pet\/Ct and carbohydrate antigen 19-9 in predicting lymph node micrometastases of pancreatic cancer","volume":"44","author":"Wang","year":"2019","journal-title":"Abdominal Radiol (New York)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1007\/s11605-015-3057-z","article-title":"A pilot study evaluating serum Mmp7 as a preoperative prognostic marker for pancreatic ductal adenocarcinoma patients","volume":"20","author":"Wang","year":"2016","journal-title":"J Gastrointest Surg"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1038\/nrclinonc.2017.141","article-title":"Radiomics: The bridge between medical imaging and personalized medicine","volume":"14","author":"Lambin","year":"2017","journal-title":"Nat Rev Clin Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v27.i35.5851","article-title":"Pancreatic cancer in 2021: What you need to know to win","volume":"27","author":"Tonini","year":"2021","journal-title":"World J Gastroenterol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-003-7165-7","article-title":"Treatment of pancreatic cancer: Challenge of the facts","volume":"27","author":"Beger","year":"2003","journal-title":"World J Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1007\/s00595-019-01804-x","article-title":"Conversion surgery for initially unresectable pancreatic cancer: Current status and unresolved issues","volume":"49","author":"Yoshitomi","year":"2019","journal-title":"Surg Today"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-020-05503-4","article-title":"Role of conversion surgery for unresectable pancreatic cancer after long-term chemotherapy","volume":"44","author":"Tsuchiya","year":"2020","journal-title":"World J Surg"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002668","article-title":"Proposed modification of the 8th edition of the ajcc staging system for pancreatic ductal adenocarcinoma","volume":"269","author":"Shi","year":"2019","journal-title":"Ann Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1002\/jhbp.940","article-title":"Peritumoral lymph nodes in pancreatic cancer revisited; is it truly equivalent to lymph node metastasis","volume":"28","author":"Byun","year":"2021","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-009-0919-2","article-title":"The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer","volume":"13","author":"Riediger","year":"2009","journal-title":"J Gastrointest Surg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2016.68.5081","article-title":"Neoadjuvant therapy followed by resection versus upfront resection for resectable pancreatic cancer: A propensity score matched analysis","volume":"35","author":"Mokdad","year":"2017","journal-title":"Off J Am Soc Clin Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25763","article-title":"Neoadjuvant therapy is associated with improved survival in resectable pancreatic adenocarcinoma","volume":"117","author":"Artinyan","year":"2011","journal-title":"Cancer"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2008.12.020","article-title":"Adjuvant chemoradiation therapy for pancreatic adenocarcinoma: Who really benefits","volume":"208","author":"Merchant","year":"2009","journal-title":"J Am Coll Surgeons"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2017.05.003","article-title":"Value of lymph node positivity in treatment planning for early stage pancreatic cancer","volume":"162","author":"Tran Cao","year":"2017","journal-title":"Surgery"},{"key":"B24","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1186\/s12957-021-02445-6","article-title":"A nomogram model for predicting prognosis of obstructive colorectal cancer","volume":"19","author":"Lv","year":"2021","journal-title":"World J Surg Oncol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S329925","article-title":"Predict lymph node metastasis in penile cancer using clinicopathological factors and nomograms","volume":"13","author":"Shao","year":"2021","journal-title":"Cancer Manag Res"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-020-05770-1","article-title":"White blood cell count and the risk of colon cancer","volume":"47","author":"Yj","year":"2006","journal-title":"Yonsei Med J"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.690324","article-title":"Predictive nomogram and risk factors for lymph node metastasis in bladder cancer","volume":"11","author":"Tian","year":"2021","journal-title":"Front Oncol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.771226","article-title":"Risk factors, prognostic factors, and nomogram for distant metastasis in breast cancer patients without lymph node metastasis","volume":"12","author":"Min","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-014-0875-y","article-title":"Penile cancer: Impact of age at diagnosis on morphology and prognosis","volume":"47","author":"Paiva","year":"2015","journal-title":"Int Urol Nephrol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/pore.2022.1610191","article-title":"Identification of predictive factors for lymph node metastasis in Pt1 stage colorectal cancer patients: A retrospective analysis based on the population database","volume":"28","author":"Song","year":"2022","journal-title":"Pathol Oncol Res"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.5306\/wjco.v13.i6.520","article-title":"Risk factors for lymph node metastasis in patients with pancreatic neuroendocrine neoplasms","volume":"13","author":"Nakao","year":"2022","journal-title":"World J Clin Oncol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"22873","DOI":"10.1038\/s41598-021-02305-z","article-title":"A nomogram to predict risk of lymph node metastasis in early gastric cancer","volume":"11","author":"Zhang","year":"2021","journal-title":"Sci Rep"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-021-01819-2","article-title":"Lymph node metastatic patterns and survival predictors based on tumor size in pancreatic ductal adenocarcinoma","volume":"38","author":"Pu","year":"2021","journal-title":"Adv Ther"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1080\/01635581.2017.1324993","article-title":"Associations between nutritional parameters and clinicopathologic factors in patients with gastric cancer: A comprehensive study","volume":"69","author":"Brewczynski","year":"2017","journal-title":"Nutr Cancer"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-021-01174-7","article-title":"Risk factors for lymph node metastasis in gastric neuroendocrine tumor: A retrospective study","volume":"21","author":"Li","year":"2021","journal-title":"BMC Surg"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2891-9-69","article-title":"Pretreatment serum albumin as a predictor of cancer survival: A systematic review of the epidemiological literature","volume":"9","author":"Gupta","year":"2010","journal-title":"Nutr J"},{"key":"B37","article-title":"Analysis of survival factors in patients with advanced-stage gastric adenocarcinoma","volume":"12","author":"Alici","year":"2006","journal-title":"Med Sci Monit"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.786207","article-title":"A predictive nomogram for lymph node metastasis in supraglottic laryngeal squamous cell carcinoma","volume":"12","author":"Song","year":"2022","journal-title":"Front Oncol"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2006.01.007","article-title":"Macrophages: Obligate partners for tumor cell migration, invasion, and metastasis","volume":"124","author":"Condeelis","year":"2006","journal-title":"Cell"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1038\/nrc1256","article-title":"Tumour-educated macrophages promote tumour progression and metastasis","volume":"4","author":"Pollard","year":"2004","journal-title":"Nat Rev Canc"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13236131","article-title":"Neutrophil extracellular traps (Nets) in cancer metastasis","volume":"13","author":"Kaltenmeier","year":"2021","journal-title":"Cancers (Basel)"},{"key":"B42","doi-asserted-by":"publisher","first-page":"543","DOI":"10.21037\/atm.2019.09.127","article-title":"Preoperative assessment of lymph node metastasis in clinically node-negative rectal cancer patients based on a nomogram consisting of five clinical factors","volume":"7","author":"Zhou","year":"2019","journal-title":"Ann Transl Med"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.24341","article-title":"A combination of circulating tumor cells and Ca199 improves the diagnosis of pancreatic cancer","volume":"36","author":"Chen","year":"2022","journal-title":"J Clin Lab Anal"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.21037\/hbsn.2019.08.01","article-title":"Modification of the 8(Th) ajcc staging system of pancreatic ductal adenocarcinoma","volume":"9","author":"Nagaria","year":"2020","journal-title":"Hepatobiliary Surg Nutr"},{"key":"B45","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1016\/j.surg.2014.06.016","article-title":"Question sets and answers","volume":"156","author":"de Virgilio","year":"2015","journal-title":"Surgery"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1053375\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T06:27:41Z","timestamp":1674628061000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1053375\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,25]]},"references-count":45,"alternative-id":["10.3389\/fonc.2023.1053375"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2023.1053375","relation":{},"ISSN":["2234-943X"],"issn-type":[{"type":"electronic","value":"2234-943X"}],"subject":[],"published":{"date-parts":[[2023,1,25]]},"article-number":"1053375"}}