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Competing risks and cause-specific mortality in patients with pancreatic neuroendocrine tumors

Li, Zhuyin; Du, Shuai; Feng, Wei; Zhang, Weibo; Li, Guochuang; Wei, Junfeng; Zhang, Guoqing; Zhao, Longshuan

European Journal of Gastroenterology & Hepatology: July 2019 - Volume 31 - Issue 7 - p 749–755
doi: 10.1097/MEG.0000000000001350
Original Articles: Gastroenterology
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Background and objective Currently, there are no competing risk analyses of cause-specific mortality in patients with pancreatic neuroendocrine tumors.

Materials and methods We estimated a cumulative incidence function for cause-specific mortality. The first nomogram for predicting cause-specific mortality was constructed using a proportional subdistribution hazard model, validated using bootstrap cross-validation, and evaluated with decision curve analysis.

Results Sex, age, positive lymph node status, metastasis, surveillance, epidemiology, and end results historic stage, grade, and surgery strongly predicted cause-specific mortality. The discrimination performance of Fine–Gray models was evaluated using the c-index, which was 0.864. In addition, the calibration plot of the developed nomogram demonstrated good concordance between the predicted and actual outcomes. Decision curve analysis yielded a range of threshold probabilities (0.014–0.779) at which the clinical net benefit of the risk model was greater than that in hypothetical all-screening or no-screening scenarios.

Conclusion Our nomogram allows selection of a patient population at high risk for cancer-specific mortality and thus facilitates the design of prevention trials for the affected population.

First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China

Correspondence to Guoqing Zhang, MD, Department of Surgery, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou 450052, Henan Province, China Tel: +86 371 6691 3114; fax: +86 371 6691 6261; e-mail: drzhangguoqing@163.com

Received September 21, 2018

Accepted December 5, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.