A prognostic Bayesian network that makes personalized predictions of poor prognostic outcome post resection of pancreatic ductal adenocarcinoma.

A prognostic Bayesian network that makes personalized predictions of poor prognostic outcome post resection of pancreatic ductal adenocarcinoma.

Publication date: Mar 12, 2019

The narrative surrounding the management of potentially resectable pancreatic cancer is complex. Surgical resection is the only potentially curative treatment. However resection rates are low, the risk of operative morbidity and mortality are high, and survival outcomes remain poor. The aim of this study was to create a prognostic Bayesian network that pre-operatively makes personalized predictions of post-resection survival time of 12months or less and also performs post-operative prognostic updating.

A Bayesian network was created by synthesizing data from PubMed post-resection survival analysis studies through a two-stage weighting process. Input variables included: inflammatory markers, tumour factors, tumour markers, patient factors and, if applicable, response to neoadjuvant treatment for pre-operative predictions. Prognostic updating was performed by inclusion of post-operative input variables including: pathology results and adjuvant therapy.

77 studies (n = 31,214) were used to create the Bayesian network, which was validated against a prospectively maintained tertiary referral centre database (n = 387). For pre-operative predictions an Area Under the Curve (AUC) of 0.7 (P value: 0.001; 95% CI 0.589-0.801) was achieved accepting up to 4 missing data-points in the dataset. For prognostic updating an AUC 0.8 (P value: 0.000; 95% CI:0.710-0.870) was achieved when validated against a dataset with up to 6 missing pre-operative, and 0 missing post-operative data-points. This dropped to AUC: 0.7 (P value: 0.000; 95% CI:0.667-0.818) when the post-operative validation dataset had up to 2 missing data-points.

This Bayesian network is currently unique in the way it utilizes PubMed and patient level data to translate the existing empirical evidence surrounding potentially resectable pancreatic cancer to make personalized prognostic predictions. We believe such a tool is vital in facilitating better shared decision-making in clinical practice and could be further developed to offer a vehicle for delivering personalized precision medicine in the future.

Open Access PDF

Bradley, A., Van der Meer, R., and McKay, C.J. A prognostic Bayesian network that makes personalized predictions of poor prognostic outcome post resection of pancreatic ductal adenocarcinoma. 05374. 2019 PLoS One (14):9.

Concepts Keywords
Adjuvant Therapy Pancreatic ductal adenocarcinoma
AUC Neoadjuvant treatment
Bayesian Network Adjuvant therapy
Empirical Evidence Medicine
Missing Data Clinical medicine
Morbidity Medical specialties
Mortality Gastrointestinal cancer
Neoadjuvant Bayesian network
Pancreatic Ductal Adenocarcinoma Pancreatic cancer
Pathology Transoral robotic surgery
PubMed
Resection
Surgical Resection
Tertiary Referral Centre
Tumour

Semantics

Type Source Name
gene UNIPROT DLD
gene UNIPROT LDHD
disease DOID Liver Disease
disease MESH Liver Disease
disease MESH death
gene UNIPROT PDGFB
drug DRUGBANK Nonoxynol-9
gene UNIPROT LITAF
gene UNIPROT ELK3
gene UNIPROT EPHB1
gene UNIPROT SLC6A2
gene UNIPROT SCN8A
disease MESH Development
gene UNIPROT MAG
drug DRUGBANK Amlodipine
drug DRUGBANK Medroxyprogesterone acetate
drug DRUGBANK Coenzyme M
disease DOID pancreatic adenocarcinoma
gene UNIPROT FTCDNL1
gene UNIPROT MS4A2
gene UNIPROT BPIFA4P
gene UNIPROT CPOX
gene UNIPROT SULT2A1
gene UNIPROT CEACAM5
drug DRUGBANK Saquinavir
drug DRUGBANK Aspartame
gene UNIPROT TNFRSF11A
gene UNIPROT ARSA
drug DRUGBANK Acetylsalicylic acid
gene UNIPROT CSRP1
gene UNIPROT CRP
disease DOID Cancer
disease MESH residual tumour
gene UNIPROT DEPP1
gene UNIPROT CCAR1
gene UNIPROT SERPINE1
disease MESH arcs
gene UNIPROT LARGE1
gene UNIPROT GOPC
disease MESH diagnosis
gene UNIPROT MALL
gene UNIPROT ABCC8
disease MESH complications
disease MESH malignancies
gene UNIPROT ATIC
gene UNIPROT NHS
gene UNIPROT TNIP1
drug DRUGBANK Tropicamide
gene UNIPROT DNMT1
gene UNIPROT CD69
pathway BSID Pancreatic cancer
disease DOID pancreatic cancer
disease MESH pancreatic cancer
disease DOID pancreatic ductal adenocarcinoma
gene UNIPROT SLC35G1
gene UNIPROT DESI1

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