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The aim of this study is to create the first Personalized Prognostic Bayesian Network for Pancreatic Cancer (PPBN-PC) to provide personalized predictions of 3-year or more survival time post resection. PPBN-PC’s ability to handle the dynamic nature of the care processes, with predictions evolving as more information becomes available, was assessed at the pre and post-operative stage of the patient journey.
Materials and Methods:
Parent nodes were identified from PubMed survival analysis studies (n=48691) and included: tumour factors, patient factors, tumour markers, inflammatory markers, neoadjuvant therapy, pathology and adjuvant therapy. Variables underwent a two-stage weighting process to summarise both the weight of the evidence against conflicting findings and a normalized weighting process placing each variable’s weighting within the entirety of the existing body of evidence. Priors for the model were calculated using the normalized weight for each variable as the weighted mean of the TNormal distribution for the corresponding parent node.
The PPBN-PC was validated against a dataset of 365 patients who presented to a tertiary referral centre with potentially resectable pancreatic cancer. Model performance measured by Area Under the Curve (AUC) ranged from 0.94 (P-value 0.002; 95% CI 0.859-1.000) for 0 missing data points to AUC 0.74 (P-value 0.000; 95% CI 0.660-0.809) accepting more than 4 missing data points in the validation dataset, for accuracy of pre-operative predictions. PPBN-PC performance for prognostic updating based on post-operatively available information ranged from AUC 0.97 (P-value 0.000; 95% CI 0.908-1.000) for 0 missing data points in pre and post-operative validation dataset to AUC 0.75 (P-value 0.000; 95% CI 0.655-0.838) accepting more than 4 missing data points in the pre and up to and including 2 missing data points in the post-operative validation dataset. The latter was the only point at which AUC fell below 0.80. Validated against every other combination of missing pre and post-operative data points PPBN-PC maintained an AUC greater than 0.8 (range 0.97-0.80) with P-value consistently below 0.001.
This marks an important step towards achieving the delivery of precision medicine, as the next step will be to incorporated genomic data into the model hence combining genetic, pathology and clinical data, creating a vehicle to deliver personalized precision medicine.
|Number of pages||2|
|Publication status||Published - 5 Jun 2019|
|Event||51st Annual Meeting of the European Pancreatic Club - Grieghallen, Bergen, Norway|
Duration: 26 Jun 2019 → 29 Jun 2019
- pancreatic cancer
- bayesian network
- personalized medicine
- prognostic model development
- prognostic health management
- personalized cancer management
A systematic review of methodological quality of model development studies predicting prognostic outcome for resectable pancreatic cancerBradley, A., Van Der Meer, R. & McKay, C. J., 21 Aug 2019, In: BMJ Open. 9, 8, 9 p., e027192.
Research output: Contribution to journal › Article › peer-reviewOpen AccessFile1 Citation (Scopus)5 Downloads (Pure)
Upfront surgery versus neoadjuvant therapy for resectable pancreatic cancer: systematic review and Bayesian network meta-analysisBradley, A. & Van Der Meer, R., 13 Mar 2019, In: Scientific Reports. 9, 1, 7 p., 4354.
Research output: Contribution to journal › Article › peer-reviewOpen AccessFile15 Citations (Scopus)12 Downloads (Pure)