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The Difficulty of Detecting Occult Metastases in Patients with Potentially Resectable Pancreatic Cancer: Development

Marieke Walma1,2, Laura Maggino3, F Jasmijn Smits1

  • 1Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St. Antonius Hospital, University Utrecht, 3508 GA Utrecht, The Netherlands.

Journal of Clinical Medicine
|March 28, 2024
PubMed
Summary

A predictive model for occult metastases in pancreatic cancer was developed but showed poor performance upon external validation. This highlights challenges in accurately identifying hidden cancer spread before surgery.

Keywords:
occult metastasespancreatic cancerprediction model

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Medical Informatics

Background:

  • Occult metastases are found in 10-15% of patients undergoing surgery for pancreatic cancer.
  • Accurate prediction of these hidden metastases is crucial for treatment planning and patient outcomes.

Purpose of the Study:

  • To develop and externally validate a predictive model for occult metastases in potentially resectable pancreatic cancer.
  • To identify key clinical and imaging factors associated with the presence of occult metastases.

Main Methods:

  • A multivariable logistic regression model was developed using data from the Dutch Pancreatic Cancer Audit (2013-2017).
  • Predictors included patient demographics, tumor characteristics, and preoperative imaging findings.
  • External validation was performed using a cohort from the University Hospital of Verona (2013-2017).

Main Results:

  • The model development cohort included 2262 patients, with 10% having occult metastases.
  • Significant predictors included age, BMI, nutritional support, tumor diameter, solid tumor composition, and indeterminate preoperative imaging lesions.
  • External validation demonstrated poor discrimination, with a C-statistic of 0.56.

Conclusions:

  • While several factors are associated with occult metastases, the developed predictive model demonstrated insufficient performance upon external validation.
  • Further research is needed to improve the accuracy of predicting occult metastases in pancreatic cancer patients eligible for surgery.