Nomogram Constructing And Verifying Of Pancreatic Head Neuroendocrine Carcinoma Patients Based On The SEER Database

Background and Purpose:Pancreatic neuroendocrine carcinoma(pan NEC)is one of pancreatic neuroendocrine tumors of the digestive system,originating in the neuroendocrine system APUD cells(Amine Precursor Uptake Decarboxylation cell).APUD cells originate from the endoderm and are homologous to the digestive tract epithelium.They originate from totipotent stem cells,which undergo malignant transformation under the action of carcinogenic factors and can differentiate into neuroendocrine carcinoma,squamous cell carcinoma or adenocarcinoma.Pancreatic neuroendocrine tumor(Pan NET)could be classified according to proliferative activity based on the degree of differentiation.Among them,G1(Ki-67 index≤3%),G2(Ki-67 index 3%～20%)and G3(Ki-67 index >20%)is known as Pan NET,and the poor differentiated G3 stage is known as Pan NEC.Pancreatic endocrine carcinoma has a poor prognosis compared with endocrine tumors,so it is important to identify the factors influencing prognosis for the development of individualized treatment.Due to the low incidence of pan NEC,the factors influencing prognosis are not entirely clear.Although previous studies have analyzed the factors affecting the prognosis of pan NEC,the prognosis and probability of pancreatic endocrine cancer occurring in the head or tail of the pancreatic body are different,and the former has a high incidence.Based on the concept of precision medicine,we will discuss the disease characteristics of neuroendocrine cancer of the head of the pancreas in this paper.Methods:Basic and therapeutic information of 210 patients diagnosed with pan NEC of the head from the SEER database of the National Cancer Institute from 2005 to 2019 were retrospectively collected and randomly divided into a training set and a validation set in a 7:3 ratio.The Cox proportional risk model was used to construct a nomogram,which was validated and compared with the eighth edition of AJCC.Results:Tumor differentiation,T stage and treatment were independent risk factors for prognosis of pan NEC patients with pancreatic head(P<0.05).The C-index of the nomogram was 0.852 and 0.927 and the AUROC of 1,2 and 3-year overall survival was 0.912,0.924,0.922 and0.973,0.969,0.988 in the training set and the validation set,respectively.The C-index and AUROC of the nomogram were higher than those of AJCC staging.The calibration curve showed that the nomogram was well calibrated.The clinical decision curve showed a higher net benefit and prediction accuracy than AJCC staging.Conclusion:The nomogram constructed based on SEER database can individually predict the prognosis of pan NEC patients with pancreatic head,and provide reference and evaluation of the disease for clinical treatment.