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Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology

4653 - Survival-associated factors and a prognostic nomogram in resected pancreatic cancer: A large international population-based cohort study


21 Oct 2018


Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology


Translational Research

Tumour Site

Pancreatic Adenocarcinoma


Lei Huang


Annals of Oncology (2018) 29 (suppl_8): viii205-viii270. 10.1093/annonc/mdy282


L. Huang1, Y. Balavarca2, L. van der Geest3, V. Lemmens3, L. van Eycken4, H. De Schutter5, T.B. Johannesen6, V. Zadnik7, M. Primic-Žakelj7, M. Mägi8, R. Grützmann9, M.G. Besselink10, P. Schrotz-King2, H. Brenner1, L. Jansen1

Author affiliations

  • 1 Division Of Clinical Epidemiology And Aging Research, German Cancer Research Center, 69120 - Heidelberg/DE
  • 2 Division Of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 - Heidelberg/DE
  • 3 Netherlands Cancer Registry (ncr), Netherlands Cancer Registry (NCR), Netherlands Comprehensive Cancer Organization (IKNL), Utrecht/NL
  • 4 Belgian Cancer Registry (bcr), Belgian Cancer Registry (BCR), Brussels/BE
  • 5 Research Department, Belgian Cancer Registry, 1210 - Brussels/BE
  • 6 Registry Department, The Cancer Registry of Norway (CRN), Oslo/NO
  • 7 Epidemiology And Cancer Registry, Institute of Oncology Ljubljana, Ljubljana/SI
  • 8 Estonian Cancer Registry, National Institute for Health Development, Tallinn/EE
  • 9 Department Of Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen/DE
  • 10 Dutch Pancreatic Cancer Group (dpcg), Department Of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam/NL

Abstract 4653


Pancreatic cancer (PaC) remains extremely lethal worldwide even after resection. This large international population-based study aimed at exploring factors associated with survival in resected PaC, and at developing and globally validating a survival-predicting nomogram.


Data of PaC patients resected in 2003-2014 were obtained from multiple European national cancer registries and the US SEER-18 Program. Multivariable Cox proportional hazards models were constructed to investigate the associations of patient and tumor characteristics with overall survival. 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 databases. Predictive accuracy was assessed using the concordance-index.


Totally 24,863 resected PaC patients were included, with median survival of 12-19 months and 3-year survival rates of 14%-28%. In main analysis, patient age, tumor T, N, and M stages, histology, and differentiation were significantly associated with survival, with country-specific association patterns and strengths. Additionally, hospital type, tumor size, harvested lymph node number, performance status, and certain comorbidities were associated with survival in countries with available information. A nomogram incorporating the backward-selected variables in the main analysis was established. Calibration curves showed good agreement between nomogram-prediction and actual observation. The concordance-index of the nomogram was significantly higher than that of the TNM staging for predicting survival.


In these international population-based cohorts, resected PaC patients have distinct characteristics independently associated with survival. A personalized postoperative survival-predicting nomogram is established and internationally validated, which would be practical and helpful clinically and aid to patient stratification in international studies.

Clinical trial identification

Legal entity responsible for the study

Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ).


German Cancer Aid (Deutsches Krebshilfe).

Editorial Acknowledgement



All authors have declared no conflicts of interest.

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