Development and validation of machine learning nomograms for predicting survival in stage IV pancreatic cancer: A retrospective study.

[BACKGROUND] Stage IV pancreatic cancer (PC) has a poor prognosis and lacks individualized prognostic tools. Current survival prediction models are limited, and there is a need for more accurate, personalized methods. The Surveillance, Epidemiology, and End Results (SEER) database offers a valuable resource for studying large patient cohorts, yet machine learning-based nomograms for stage IV PC prognosis remain underexplored. This study hypothesizes that a machine learning-based nomogram can predict cancer-specific survival (CSS) and overall survival (OS) with high accuracy in stage IV PC patients.

[AIM] To construct and validate a machine learning-based nomogram for predicting survival in stage IV PC patients using real-world data.

[METHODS] Clinical data from stage IV PC patients diagnosed pathology from 2000 to 2019 were extracted from the SEER database. Patients were randomly divided into a training set and a validation set in a 7:3 ratio. Multivariate Cox proportional hazards, Least Absolute Shrinkage and Selection Operator regression, and Random Survival Forest models were used to identify prognostic variables. A nomogram was constructed to predict CSS and OS at 6, 12, and 18 months. The C-index, receiver operating characteristic curves, and calibration curves were used to evaluate the model's predictive performance.

[RESULTS] A total of 1662 patients were included (1163 in the training set, 499 in the validation set). The median follow-up times were 4 months [interquartile range (IQR): 1-10 months] for the training set and 4 months (IQR: 1-11 months) for the validation set. Key independent prognostic factors identified included age, race, marital status, tumor location, N stage, grade, surgery, chemotherapy, and liver metastasis. The nomogram accurately predicted OS and CSS at 6, 12, and 18 months, with a C-index of 0.727 (OS) and 0.727 (CSS) in the training set, and 0.719 (OS) and 0.716 (CSS) in the validation set. Calibration curves demonstrated excellent model accuracy.

[CONCLUSION] The nomogram developed using age, grade, chemotherapy, surgery, and liver metastasis as predictors can reliably estimate survival outcomes for stage IV PC patients and offers a potential tool for individualized clinical decision-making.