ArticleJournal of gastrointestinal oncology2026
A biomarker-integrated nomogram for predicting postoperative pancreatic fistula in low- to intermediate-risk patients after pancreaticoduodenectomy.
Article in Journal of gastrointestinal oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Postoperative pancreatic fistula (POPF) remains one of the most common and life-threatening complications following pancreaticoduodenectomy (PD), yet effective and individualized prediction methods are lacking. This study aimed to identify risk factors and construct a nomogram to predict the risk of POPF. Methods: Clinical data were collected from patients who underwent PD between January 2019 and May 2021 in the Department of Pancreatic and Metabolic Surgery at Nanjing Drum Tower Hospital. Risk factors identified from univariate and multivariate analyses were incorporated into a nomogram. Model performance and its clinical utility were assessed using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Results: A total of 195 patients with low or intermediate risk of POPF were included. Univariate and multivariate analyses identify that high-risk pathology, soft pancreatic texture, Wirsung diameter, procalcitonin (PCT) on postoperative day (POD) 3 >0.229 ng/mL and C-reactive protein (CRP) on POD3 >111.15 mg/L were independent risk factors for POPF. The nomogram was constructed with the 5 risk factors. AUC of the nomogram was 0.9374 [95% confidence interval (CI): 0.9056-0.9692]. Bootstrap-corrected calibration curves showed close alignment between predicted and observed POPF probabilities. DCA showed that the nomogram provided higher net benefit across a wide range of threshold probabilities compared to the "treat all" or "treat none" strategies. Conclusions: We developed a nomogram that integrates intraoperative factors with early postoperative serum biomarkers for patients with low to intermediate risk of POPF after PD. The nomogram may assist clinicians in guiding postoperative decision-making and improve clinical outcomes.
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