Pancreatic ductal adenocarcinoma: a radiomics nomogram outperforms clinical model and TNM staging for survival estimation after curative resection

Objectives To identify a CT-based radiomics nomogram for survival prediction in patients with resected pancreatic ductal adenocarcinoma (PDAC). Methods A total of 220 patients (training cohort n = 147; validation cohort n = 73) with PDAC were enrolled. A total of 300 radiomics features were extracted from CT images. And the least absolute shrinkage and selection operator algorithm were applied to select features and develop a radiomics score (Rad-score). The radiomics nomogram was constructed by multivariate regression analysis. Nomogram discrimination, calibration, and clinical usefulness were evaluated. The association of the Rad-score and recurrence pattern in PDAC was evaluated. Results The Rad-score was significantly associated with PDAC patient's disease-free survival (DFS) and overall survival (OS) (both p < 0.001 in two cohorts). Incorporating the Rad-score into the radiomics nomogram resulted in better performance of the survival prediction than that of the clinical model and TNM staging system. In addition, the radiomics nomogram exhibited good discrimination, calibration, and clinical usefulness in both the training and validation cohorts. There was no association between the Rad-score and recurrence pattern. Conclusions The radiomics nomogram integrating the Rad-score and clinical data provided better prognostic prediction in resected PDAC patients, which may hold great potential for guiding personalized care for these patients. The Rad-score was not a predictor of the recurrence pattern in resected PDAC patients.