Development and Validation of Nomograms for Predicting Overall Survival and Recurrence After Upfront Pancreatic Resection for Ductal Adenocarcinoma: A Single-Institution Analysis of 2958 Patients.

Abstract

Reliable prediction of overall survival and recurrence after resection for pancreatic ductal adenocarcinoma (PDAC) remains a critical unmet need. Dual nomograms for overall survival (OS) and recurrence were constructed using backward stepwise selection, validated with bootstrap resampling (500 iterations) and a 7:3 training-validation split. Risk stratification was performed using X-tile-optimized cutpoints. The median OS was 22.4 months, and the 5-year survival rate was 18.0%. The OS nomogram (10 predictors) achieved an area under the receiver operating characteristic curve (AUC) of 0.780 in the validation set. The recurrence nomogram (8 predictors) achieved an AUC of 0.732 in the validation set. Both models demonstrated excellent calibration and clinical utility. Eastern Cooperative Oncology Group (ECOG) performance status and adjuvant chemotherapy were the strongest predictors for both endpoints. Peripancreatic fat infiltration was a particularly strong driver of recurrence (OR 2.19). Risk stratification classified patients into low-, intermediate-, and high-risk groups with significantly different outcomes (P < 0.001). The proposed dual nomograms provide individualized prediction of OS and recurrence risk with robust discrimination and calibration. These tools may assist clinicians in risk stratification and postoperative surveillance planning.