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


Authors: Pak, L. M.; Gonen, M.; Seier, K.; Balachandran, V. P.; D’Angelica, M. I.; Jarnagin, W. R.; Kingham, T. P.; Allen, P. J.; Do, R. K. G.; Simpson, A. L.
Article Title: Can physician gestalt predict survival in patients with resectable pancreatic adenocarcinoma?
Abstract: 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. © 2017, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: survival; prediction; pancreatic adenocarcinoma; nomogram
Journal Title: Abdominal Radiology
Volume: 43
Issue: 8
ISSN: 2366-004X
Publisher: Springer  
Date Published: 2018-08-01
Start Page: 2113
End Page: 2118
Language: English
DOI: 10.1007/s00261-017-1407-x
PROVIDER: scopus
PMCID: PMC5967975
PUBMED: 29177926
DOI/URL:
Notes: Article -- Export Date: 4 September 2018 -- Source: Scopus
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MSK Authors
  1. Mithat Gonen
    716 Gonen
  2. Peter Allen
    442 Allen
  3. William R Jarnagin
    596 Jarnagin
  4. Kinh Gian Do
    116 Do
  5. T Peter Kingham
    293 Kingham
  6. Amber L Simpson
    52 Simpson
  7. Linda Ma
    17 Ma
  8. Kenneth Seier
    23 Seier