Prognosis analysis and recurrence prediction of patients with radical resection of pancreatic neuroendocrine neoplasms: a nomogram-based study

Background Pancreatic neuroendocrine neoplasms (pNENs) has high postoperative recurrence rate while lacking prognostic indicators. Aim of this study was to establish a nomogram to predict it. Methods We retrospectively analyzed 180 cases of resectable pNENs and used Cox regression analysis to identify the significant prognostic factors of Overall Survival (OS) and Relapse-Free Survival (RFS). Based on the three independent prognostics factors (World Health Organization (WHO) classification, American Joint Committee on Cancer (AJCC) staging, and neutrophil-to-lymphocyte ratio (NLR)), we developed a nomogram model to predict RFS probability of pNENs. The predictive accuracy was assessed using a calibration plot, concordance index (C-index) and decision curve. Results Univariate analysis showed that AJCC staging, WHO classification, vascular infiltration, nerve invasion, NLR were independent prognostic factors associated with Overall Survival and RFS of patients (P < 0.05). But only AJCC 8th edition clinical TNM staging, WHO classification and NLR classification (≤2.61 and >2.61) had significant differences ( P < 0.05) in multivariate analysis. The ROC curve illustrated integrated factors have an AUC of 0.906 (95% CI 0.832-0.979) and decision curve demonstrated the nomogram was better than traditional staging system. Conclusions The preoperative NLR is a potential independent predictor for RFS of NF-pNENs. The established nomogram is associated with a more accurate recurrence prediction for individual patients with resectable pNENs.