{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T01:47:56Z","timestamp":1768528076176,"version":"3.49.0"},"reference-count":45,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:00:00Z","timestamp":1710374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Occult metastases are detected in 10\u201315% of patients during exploratory laparotomy for pancreatic cancer. This study developed and externally validated a model to predict occult metastases in patients with potentially resectable pancreatic cancer. Model development was performed within the Dutch Pancreatic Cancer Audit, including all patients operated for pancreatic cancer (January 2013\u2013December 2017). Multivariable logistic regression analysis based on the Akaike Information Criteria was performed with intraoperative pathologically proven metastases as the outcome. The model was externally validated with a cohort from the University Hospital of Verona (January 2013\u2013December 2017). For model development, 2262 patients were included of whom 235 (10%) had occult metastases, located in the liver (n = 143, 61%), peritoneum (n = 73, 31%), or both (n = 19, 8%). The model included age (OR 1.02, 95% CI 1.00\u20131.03), BMI (OR 0.96, 95% CI 0.93\u20130.99), preoperative nutritional support (OR 1.73, 95% CI 1.01\u20132.74), tumor diameter (OR 1.60, 95% CI 1.04\u20132.45), tumor composition (solid vs. cystic) (OR 2.33, 95% CI 1.20\u20134.35), and indeterminate lesions on preoperative imaging (OR 4.01, 95% CI 2.16\u20137.43). External validation showed poor discrimination with a C-statistic of 0.56. Although some predictor variables were significantly associated with occult metastases, the model performed insufficiently at external validation.<\/jats:p>","DOI":"10.3390\/jcm13061679","type":"journal-article","created":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T04:47:05Z","timestamp":1710478025000},"page":"1679","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Difficulty of Detecting Occult Metastases in Patients with Potentially Resectable Pancreatic Cancer: Development and External Validation of a Preoperative Prediction Model"],"prefix":"10.3390","volume":"13","author":[{"given":"Marieke","family":"Walma","sequence":"first","affiliation":[{"name":"Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St. Antonius Hospital, University Utrecht, 3508 GA Utrecht, The Netherlands"},{"name":"Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Maggino","sequence":"additional","affiliation":[{"name":"The Pancreas Institute, University of Verona Hospital Trust, 37134 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F. Jasmijn","family":"Smits","sequence":"additional","affiliation":[{"name":"Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St. Antonius Hospital, University Utrecht, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia S.","family":"Borggreve","sequence":"additional","affiliation":[{"name":"Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St. Antonius Hospital, University Utrecht, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lois A.","family":"Daamen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St. Antonius Hospital, University Utrecht, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent P.","family":"Groot","sequence":"additional","affiliation":[{"name":"Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St. Antonius Hospital, University Utrecht, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8225-2399","authenticated-orcid":false,"given":"Fabio","family":"Casciani","sequence":"additional","affiliation":[{"name":"The Pancreas Institute, University of Verona Hospital Trust, 37134 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7900-5917","authenticated-orcid":false,"given":"Vincent E.","family":"de Meijer","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank J.","family":"Wessels","sequence":"additional","affiliation":[{"name":"Department of Radiology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St. Antonius Hospital, University Utrecht, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George P.","family":"van der Schelling","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amphia Hospital Breda, 4818 CK Breda, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent B.","family":"Nieuwenhuijs","sequence":"additional","affiliation":[{"name":"Department of Surgery, Isala Hospital, 8025 AB Zwolle, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koop","family":"Bosscha","sequence":"additional","affiliation":[{"name":"Department of Surgery, Jeroen Bosch Hospital, 5223 GZ \u2018s-Hertogenbosch, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erwin van der","family":"van der Harst","sequence":"additional","affiliation":[{"name":"Department of Surgery, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald van","family":"van Dam","sequence":"additional","affiliation":[{"name":"Department of Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike S.","family":"Liem","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical Spectrum Twente, 7511 HN Enschede, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastiaan","family":"Festen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Onze Lieve Vrouwe Gasthuis, 1091 AC Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martijn W. J.","family":"Stommel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daphne","family":"Roos","sequence":"additional","affiliation":[{"name":"Department of Surgery, Reiner de Graaf Hospital, 2625 AD Delft, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fennie","family":"Wit","sequence":"additional","affiliation":[{"name":"Department of Surgery, Tjongerschans Hospital, 8441 PW Heerenveen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignace H. de","family":"de Hingh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bert A.","family":"Bonsing","sequence":"additional","affiliation":[{"name":"Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivier R.","family":"Busch","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bas","family":"Groot Koerkamp","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geert","family":"Kazemier","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc G.","family":"Besselink","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3514-8473","authenticated-orcid":false,"given":"Roberto","family":"Salvia","sequence":"additional","affiliation":[{"name":"The Pancreas Institute, University of Verona Hospital Trust, 37134 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5467-2628","authenticated-orcid":false,"given":"Giuseppe","family":"Malleo","sequence":"additional","affiliation":[{"name":"The Pancreas Institute, University of Verona Hospital Trust, 37134 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I. Quintus","family":"Molenaar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St. Antonius Hospital, University Utrecht, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hjalmar C.","family":"van Santvoort","sequence":"additional","affiliation":[{"name":"Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St. Antonius Hospital, University Utrecht, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2913","DOI":"10.1158\/0008-5472.CAN-14-0155","article-title":"Projecting cancer incidence and deaths to 2030: The unexpected burden of thyroid, liver, and pancreas cancers in the united states","volume":"74","author":"Rahib","year":"2014","journal-title":"Cancer Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA Cancer J. 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