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@ARTICLE{Huang:143168,
      author       = {L. Huang$^*$ and Y. Balavarca$^*$ and L. van der Geest and
                      V. Lemmens and L. Van Eycken and H. De Schutter and T. B.
                      Johannesen and V. Zadnik and M. Primic-Žakelj and M. Mägi
                      and R. Grützmann and M. G. Besselink and P.
                      Schrotz-King$^*$ and H. Brenner$^*$ and L. Jansen$^*$},
      title        = {{D}evelopment and validation of a prognostic model to
                      predict the prognosis of patients who underwent chemotherapy
                      and resection of pancreatic adenocarcinoma: a large
                      international population-based cohort study.3},
      journal      = {BMC medicine},
      volume       = {17},
      number       = {1},
      issn         = {1741-7015},
      address      = {Heidelberg [u.a.]},
      publisher    = {Springer},
      reportid     = {DKFZ-2019-00767},
      pages        = {66},
      year         = {2019},
      abstract     = {Pancreatic cancer (PaC) remains extremely lethal worldwide
                      even after resection. PaC resection rates are low, making
                      prognostic studies in resected PaC difficult. This large
                      international population-based study aimed at exploring
                      factors associated with survival in patients with resected
                      TNM stage I-II PaC receiving chemotherapy and at developing
                      and internationally validating a survival-predicting
                      model.Data of stage I-II PaC patients resected and receiving
                      chemotherapy in 2003-2014 were obtained from the national
                      cancer registries of Belgium, the Netherlands, Slovenia, and
                      Norway, and the US Surveillance, Epidemiology, and End
                      Results (SEER)-18 Program. Multivariable Cox proportional
                      hazards models were constructed to investigate the
                      associations of patient and tumor characteristics with
                      overall survival, and analysis was performed in each country
                      respectively without pooling. Prognostic factors remaining
                      after backward selection in SEER-18 were used to build a
                      nomogram, which was subjected to bootstrap internal
                      validation and external validation using the European
                      datasets.A total of 11,837 resected PaC patients were
                      analyzed, with median survival time of 18-23 months and
                      3-year survival rates of $21-31\%.$ In the main analysis,
                      patient age, tumor T stage, N stage, and differentiation
                      were associated with survival across most countries, with
                      country-specific association patterns and strengths.
                      However, tumor location was mostly not significantly
                      associated with survival. Resection margin, hospital type,
                      tumor size, positive and harvested lymph node number, lymph
                      node ratio, and comorbidity number were associated with
                      survival in certain countries where the information was
                      available. A median survival time- and 1-, 2-, 3-, and
                      5-year survival probability-predictive nomogram
                      incorporating the backward-selected variables in the main
                      analysis was established. It fits each European national
                      cohort similarly well. Calibration curves showed very good
                      agreement between nomogram-prediction and actual
                      observation. The concordance index of the nomogram (0.60)
                      was significantly higher than that of the T and N
                      stage-based model (0.56) for predicting survival.In these
                      large international population-based cohorts, patients with
                      resected PaC receiving chemotherapy have distinct
                      characteristics independently associated with survival, with
                      country-specific patterns and strengths. A robust benchmark
                      population-based survival-predicting model is established
                      and internationally validated. Like previous models
                      predicting survival in resected PaC, our nomogram performs
                      modestly.},
      cin          = {C070 / C120 / L101},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331 / I:(DE-He78)C120-20160331 /
                      I:(DE-He78)L101-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:30905320},
      doi          = {10.1186/s12916-019-1304-y},
      url          = {https://inrepo02.dkfz.de/record/143168},
}