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. 2023 Sep 4;13:1218128. doi: 10.3389/fonc.2023.1218128

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Copyright © 2023 Cen, Wang, Wang, Wen, Liu, Li, Wu, Huang, Ma, Liu, Wu and Han

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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A representative case to illustrate the discriminative ability of two nomograms for the classification of histological grade and the prediction of overall survival (OS). (A) A 47-year-old woman with resectable pancreatic ductal adenocarcinoma. Axial contrast material-enhanced CT images demonstrate a 1.9-cm mass (arrow) in the pancreatic head with dilatation of the pancreatic duct (arrowhead). (B) Pathological examination confirmed the diagnosis of well-differentiated pancreatic ductal adenocarcinoma (hematoxylin-eosin stain, ×40 magnification), which was low-grade. (C) Based on a radiomics score value of -3.13 (45.5 points), an increased carbohydrate antigen 12-5 (CA12-5) level (6 points) and no history of smoking (0 point), the total points of the histological grading nomogram was 51.5. The histological grading nomogram predicted that the probability of this patient being high-grade was much lower than 0.1, meaning that this patient was predicted to be low-grade. (D) After standard pancreaticoduodenectomy, the patient had tumor node metastasis (TNM) stage I, negative resection margin, no microvascular invasion (MVI), and no adjuvant treatment. In the prognostic nomogram, the radiomics score value was -3.13 (18.5 points), CA12-5 level was increased (25 points), the remaining 4 factors including TNM stage I, negative resection margin, no MVI and no adjuvant treatment were all scored as 0, and the total points was 43.5, which predicted 3-year survival probability greater than 0.9 for this patient. The patient was alive for 1221 days until the last follow-up. CA12-5, carbohydrate antigen 12-5; TNM, tumor node metastasis; MVI, microvascular invasion; OS, overall survival.