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Optimizing Postoperative Prognostication in Duodenal Adenocarcinoma: A Multicenter Study with External Validation.

Zongting Gu¹, Qifeng Xiao², Xin Wu³

¹General Surgery, Cancer Center, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.

|July 9, 2026

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Summary

A new prognostic nomogram for duodenal adenocarcinoma (DA) was developed and validated using perioperative data. This tool improves risk stratification for patients undergoing surgery, aiding clinical decisions and patient counseling.

Area of Science:

Oncology
Surgical Oncology
Biostatistics

Background:

Duodenal adenocarcinoma (DA) is a rare malignancy with variable prognoses.
Accurate prognostic tools are crucial for guiding treatment and patient management.
Existing staging systems may not fully capture individual patient risk after surgery.

Purpose of the Study:

To develop and externally validate a prognostic nomogram for overall survival (OS) in resected duodenal adenocarcinoma (DA).
To utilize routinely available perioperative variables for risk stratification.
To support clinical decision-making and patient counseling for DA.

Main Methods:

A multicenter analysis of 2,289 DA patients undergoing curative surgery was conducted.
LASSO-Cox regression identified key predictors from 89 perioperative factors.

Keywords:

Duodenal adenocarcinoma External validation LASSO-Cox regression Nomogram Prognostic model Risk stratification

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External validation was performed on 335 patients from an independent hospital.

Main Results:

The developed nomogram demonstrated good discriminative ability with 1-, 3-, and 5-year AUCs of 0.72, 0.75, and 0.76, respectively.
External validation confirmed the nomogram's performance, with AUCs of 0.76, 0.79, and 0.81 for 1-, 3-, and 5-year OS.
Eight predictors, including transfusion and operative time, were selected, and the model effectively stratified patients into low- and high-risk groups.

Conclusions:

A validated postoperative prognostic nomogram for duodenal adenocarcinoma was successfully developed.
The nomogram enhances risk stratification beyond standard staging, aiding in counseling and treatment planning.
Further validation is recommended for broader clinical implementation of this prognostic tool.