Validation and head-to-head comparison of four models for predicting malignancy of intraductal papillary mucinous neoplasm of the pancreas: A study based on endoscopic ultrasound findings  

作　　者：Jie Hua Bo Zhang Xiu-Jiang Yang Yi-Yin Zhang Miao-Yan Wei Chen Liang Qing-Cai Meng Jiang Liu Xian-Jun Yu Jin Xu Si Shi 

机构地区：[1]Department of Pancreatic Surgery,Fudan University Shanghai Cancer Center,Department of Oncology,Fudan University Shanghai Medical College,Shanghai Pancreatic Cancer Institute,Shanghai 200032,China [2]Department of Endoscopy,Fudan University Shanghai Cancer Center,Shanghai 200032,China

出　　处：《World Journal of Gastrointestinal Oncology》2019年第11期1043-1053,共11页世界胃肠肿瘤学杂志（英文版）（电子版）

基　　金：Supported by The China National Funds for Distinguished Young Scientists,No.81625016;The National Natural Science Foundation of China,No.81772555;The Science and Technology Commission of Shanghai Municipality,No.17YF1402500

摘　　要：BACKGROUND Several models are currently available for predicting the malignancy of pancreatic intraductal papillary mucinous neoplasm(IPMN),namely,the Pancreatic Surgery Consortium(PSC),the Japan Pancreas Society(JPS),the Johns Hopkins Hospital(JHH),and the Japan-Korea(JPN-KOR)models.However,a head-to-head comparison that shows which model is more accurate for this individualized prediction is lacking.AIM To perform a head-to-head comparison of the four models for predicting the malignancy of pancreatic IPMN.METHODS A total of 181 patients with IPMN who had undergone surgical resection were identified from a prospectively maintained database.The characteristics of IPMN in patients were recorded from endoscopic ultrasound imaging data and report archives.The performance of all four models was examined using Harrell’s concordance index(C-index),calibration plots,decision curve analyses,and diagnostic tests.RESULTS Of the 181 included patients,94 were categorized as having benign disease,and the remaining 87 were categorized as having malignant disease.The C-indexes were 0.842[95%confidence interval(CI):0.782-0.901],0.704(95%CI:0.626-0.782),0.754(95%CI:0.684-0.824),and 0.650(95%CI:0.483-0.817)for the PSC,JPS,JHH,and JPN-KOR models,respectively.Calibration plots showed that the PSC model had the least pronounced departure from ideal predictions.Of the remaining three models,the JPS and JHH models underestimated the probability of malignancy,while the JPN-KOR model overestimated the malignant potential of branch duct-IPMN.Decision curve analysis revealed that the PSC model resulted in a better clinical net benefit than the three other models.Diagnostic tests also showed a higher accuracy(0.801)for the PSC model.CONCLUSION The PSC model exhibited the best performance characteristics.Therefore,the PSC model should be considered the best tool for the individualized prediction of malignancy in patients with pancreatic IPMN.BACKGROUND Several models are currently available for predicting the malignancy of pancreatic intraductal papillary mucinous neoplasm(IPMN), namely, the Pancreatic Surgery Consortium(PSC), the Japan Pancreas Society(JPS), the Johns Hopkins Hospital(JHH), and the Japan-Korea(JPN-KOR) models.However, a head-to-head comparison that shows which model is more accurate for this individualized prediction is lacking.AIM To perform a head-to-head comparison of the four models for predicting the malignancy of pancreatic IPMN.METHODS A total of 181 patients with IPMN who had undergone surgical resection were identified from a prospectively maintained database.The characteristics of IPMN in patients were recorded from endoscopic ultrasound imaging data and report archives.The performance of all four models was examined using Harrell’s concordance index(C-index), calibration plots, decision curve analyses, and diagnostic tests.RESULTS Of the 181 included patients, 94 were categorized as having benign disease, and the remaining 87 were categorized as having malignant disease.The C-indexes were 0.842 [95% confidence interval(CI): 0.782-0.901], 0.704(95%CI: 0.626-0.782),0.754(95%CI: 0.684-0.824), and 0.650(95%CI: 0.483-0.817) for the PSC, JPS, JHH,and JPN-KOR models, respectively.Calibration plots showed that the PSC model had the least pronounced departure from ideal predictions.Of the remaining three models, the JPS and JHH models underestimated the probability of malignancy, while the JPN-KOR model overestimated the malignant potential of branch duct-IPMN.Decision curve analysis revealed that the PSC model resulted in a better clinical net benefit than the three other models.Diagnostic tests also showed a higher accuracy(0.801) for the PSC model.CONCLUSION The PSC model exhibited the best performance characteristics.Therefore, the PSC model should be considered the best tool for the individualized prediction of malignancy in patients with pancreatic IPMN.

关 键 词：INTRADUCTAL PAPILLARY MUCINOUS neoplasms Prediction model Endoscopic ultrasound MURAL nodules MALIGNANCY 

分 类 号：R73[医药卫生—肿瘤]