The Metroticket project

The methodological approach adopted here stems from the liver transplant oncology experience. Clinical criteria for transplant eligibility of patients with hepatocellular carcinoma (HCC) have been available since 1996 and have been refined to the more recent flexible Metroticket 2.0 model concept. In the context of HCC, eligibility criteria for transplantation are necessary due to chronic organ shortage (limited resources). In pancreatic ductal adenocarcinoma (PDAC), eligibility criteria can be used to limit surgical futility by redirecting to neoadjuvant therapy those patients who are at the highest risk of early recurrence or death (within 6 months).

For doing so, data from 1426 patients undergoing upfront pancreatectomy were abstracted from a database of 2.928 consecutive patients resected between 2010 and 2021 at the participating institutions. The study sample was split into a derivation (n=885) and a validation cohort (n=541) for the model construction. Futile pancreatectomy was defined as an operation associated with death for any cause or disease recurrence within six months. Here you can find the individual prediction model, based on ASA class, Carbohydrate antigen (Ca) 19.9, and radiological tumor size.

Open the individual futility prediction model
METROPANCREAS

In addition, four discrete conditions were identified and defined as “Ca 19.9-adjusted-to-size criteria”:

  • size <2cm with Ca 19.9<1000 U/mL,
  • size <3cm with Ca 19.9<500 U/mL,
  • size <4cm with Ca 19.9<150 U/mL
  • size <5cm with Ca 19.9 <50 U/mL

The adoption of these criteria allows to maintain the futility <20% in 99% of cases.

A preoperative model and criteria to determine the risk of futile pancreatectomy were developed. The Metro-Pancreas might help in selecting patients for upfront resection or neoadjuvant therapy.

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