Development and external validation of a prediction model for survival in patients with resected ampullary adenocarcinoma

Alma L. Moekotte, Stijn van Roessel, Giuseppe Malleo, Rushda Rajak, Brett L. Ecker, Martina Fontana, Ho Seong Han, Mohamed Rabie, Keith J. Roberts, Khalid Khalil, Steven A. White, Stuart Robinson, Asif Halimi, Laura Zarantonello, Giuseppe K. Fusai, George Gradinariu, Adnan Alseidi, Morgan Bonds, Stephan Dreyer, Nigel B. JamiesonNicholas Mowbray, Bilal Al-Sarireh, Vasileios K. Mavroeidis, Zahir Soonawalla, Niccolò Napoli, Ugo Boggi, Tara S. Kent, William E. Fisher, Chung N. Tang, Louisa Bolm, Michael G. House, Mary E. Dillhoff, Stephen W. Behrman, Masafumi Nakamura, Chad G. Ball, Adam C. Berger, John D. Christein, Amer H. Zureikat, Ronald R. Salem, Charles M. Vollmer, Roberto Salvia, Marc G. Besselink, Mohammed Abu Hilal*, Ra'ed Aljarrah, Courtney Barrows, Martha Navarro Cagigas, Eric C.H. Lai, Ulrich Wellner, John Aversa, Paxton V. Dickson, Takao Ohtsuka, Elijah Dixon, Richard Zheng, Stacy Kowalski, Mollie Freedman-Weiss

*Corresponding author for this work


Introduction: Ampullary adenocarcinoma (AAC) is a rare malignancy with great morphological heterogeneity, which complicates the prediction of survival and, therefore, clinical decision-making. The aim of this study was to develop and externally validate a prediction model for survival after resection of AAC. Materials and methods: An international multicenter cohort study was conducted, including patients who underwent pancreatoduodenectomy for AAC (2006–2017) from 27 centers in 10 countries spanning three continents. A derivation and validation cohort were separately collected. Predictors were selected from the derivation cohort using a LASSO Cox proportional hazards model. A nomogram was created based on shrunk coefficients. Model performance was assessed in the derivation cohort and subsequently in the validation cohort, by calibration plots and Uno's C-statistic. Four risk groups were created based on quartiles of the nomogram score. Results: Overall, 1007 patients were available for development of the model. Predictors in the final Cox model included age, resection margin, tumor differentiation, pathological T stage and N stage (8th AJCC edition). Internal cross-validation demonstrated a C-statistic of 0.75 (95% CI 0.73–0.77). External validation in a cohort of 462 patients demonstrated a C-statistic of 0.77 (95% CI 0.73–0.81). A nomogram for the prediction of 3- and 5-year survival was created. The four risk groups showed significantly different 5-year survival rates (81%, 57%, 22% and 14%, p < 0.001). Only in the very-high risk group was adjuvant chemotherapy associated with an improved overall survival. Conclusion: A prediction model for survival after curative resection of AAC was developed and externally validated. The model is easily available online via

Original languageEnglish
JournalEuropean Journal of Surgical Oncology
Issue number9
Pages (from-to)1717-1726
Number of pages10
Publication statusPublished - 09.2020

Research Areas and Centers

  • Research Area: Luebeck Integrated Oncology Network (LION)


Dive into the research topics of 'Development and external validation of a prediction model for survival in patients with resected ampullary adenocarcinoma'. Together they form a unique fingerprint.

Cite this