Can physician gestalt predict survival in patients with resectable pancreatic adenocarcinoma?

Journal Article (Journal Article)

PURPOSE:Clinician gestalt may hold unexplored information that can be capitalized upon to improve existing nomograms. The study objective was to evaluate physician ability to predict 2-year overall survival (OS) in resected pancreatic ductal adenocarcinoma (PDAC) patients based on pre-operative clinical characteristics and routine CT imaging. METHODS:Ten surgeons and two radiologists were provided with a clinical vignette (including age, gender, presenting symptoms, and pre-operative CA19-9 when available) and pre-operative CT scan for 20 resected PDAC patients and asked to predict the probability of each patient reaching 2-year OS. Receiver operating characteristic curves were used to assess agreement and to compare performance with an established institutional nomogram. RESULTS:Ten surgeons and 2 radiologists participated in this study. The area under the curve (AUC) for all physicians was 0.707 (95% CI 0.642-0.772). Attending physicians with > 5 years experience performed better than physicians with < 5 years of clinical experience since completion of post-graduate training (AUC = 0.710, 95% CI [0.536-0.884] compared to AUC = 0.662, 95% CI [0.398-0.927]). Radiologists performed better than surgeons (AUC = 0.875, 95% CI [0.765-0.985] compared to AUC = 0.656, 95% CI [0.580-0.732]). All but one physician outperformed the clinical nomogram (AUC = 0.604). CONCLUSIONS:This pilot study demonstrated significant promise in the quantification of physician gestalt. While PDAC remains a difficult disease to prognosticate, physicians, particularly those with more clinical experience and radiologic expertise, are able to perform with higher accuracy than existing nomograms in predicting 2-year survival.

Full Text

Duke Authors

Cited Authors

  • Pak, LM; Gonen, M; Seier, K; Balachandran, VP; D'Angelica, MI; Jarnagin, WR; Kingham, TP; Allen, PJ; Do, RKG; Simpson, AL

Published Date

  • August 2018

Published In

Volume / Issue

  • 43 / 8

Start / End Page

  • 2113 - 2118

PubMed ID

  • 29177926

Pubmed Central ID

  • PMC5967975

Electronic International Standard Serial Number (EISSN)

  • 2366-0058

International Standard Serial Number (ISSN)

  • 2366-004X

Digital Object Identifier (DOI)

  • 10.1007/s00261-017-1407-x


  • eng