J Cancer 2017; 8(3):425-433. doi:10.7150/jca.17315

Research Paper

A nomogram for predicting the probability of recurrence in patients with carcinomas located in the ampulla of Vater

Keng-Hao Liu1*, Chih-Ho Hsu1,2*, Jun-Te Hsu1, Chun-Yi Tsai1, Yu-Yin Liu 1, Tsann-Long Hwang1, Ta-Sen Yeh1,4, Yu-Shin Hung3, Wen-Chi Chou3,4✉

1. Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan;
2. Division of General Surgery, Department of Surgery, Far-Eastern Memorial Hospital, Taipei, Taiwan;
3. Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan;
4. Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.
*Both authors have equal contribution.

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Liu KH, Hsu CH, Hsu JT, Tsai CY, Liu YY, Hwang TL, Yeh TS, Hung YS, Chou WC. A nomogram for predicting the probability of recurrence in patients with carcinomas located in the ampulla of Vater. J Cancer 2017; 8(3):425-433. doi:10.7150/jca.17315. Available from http://www.jcancer.org/v08p0425.htm

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Background and Objectives: The standard treatment for carcinomas of the ampulla of Vater (CAV) is surgical resection. Nevertheless, recurrence is observed in half of the patients within five years after cancer surgery. In this study, we aimed to identify predictive factors and develop a nomogram capable of predicting the risk of recurrence in post-resection CAV patients.

Methods: Our study cohort was composed of two hundred and twelve patients who had undergone radical surgery for CAV between 2000 and 2012. Clinicopathological variables predictive of recurrence were identified using univariate analysis. A Cox proportional hazards model was used to select the predictive factors used for the nomogram.

Results: The 5-year overall survival, cancer-specific survival and disease-free survival rates were 44.3%, 51.1%, and 42.8%, respectively. The five most predictive variables for tumor recurrence were chosen to develop the nomogram. The nomogram had a highly predictive performance, with a bootstrap-corrected concordance index of 0.72 (95% confidence interval, 0.67-0.79). Furthermore, the performance of the nomogram was found to be better than the American Joint Committee on Cancer (AJCC) staging system due to better homogeneity, higher ability of discrimination and higher risk stratification of the model.

Conclusions: We developed a predictive nomogram for estimating tumor relapse probability in CAV patients after radical surgery. This nomogram might be more informative than the AJCC staging system and may allow for better estimation of the probability of relapse after surgical resections.

Keywords: Ampulla Vater cancer, recurrence probability, nomogram, calibration.