Competing risks and cause-specific mortality in patients with pancreatic neuroendocrine tumors

BACKGROUND AND OBJECTIVE: Currently, there are no competing risk analyses of cause-specific mortality in patients with pancreatic neuroendocrine tumors. MATERIALS AND METHODS: We estimated a cumulative incidence function for cause-specific mortality. The first nomogram for predicting cause-specific mortality was constructed using a proportional subdistribution hazard model, validated using bootstrap cross-validation, and evaluated with decision curve analysis. RESULTS: Sex, age, positive lymph node status, metastasis, surveillance, epidemiology, and end results historic stage, grade, and surgery strongly predicted cause-specific mortality. The discrimination performance of Fine-Gray models was evaluated using the c-index, which was 0.864. In addition, the calibration plot of the developed nomogram demonstrated good concordance between the predicted and actual outcomes. Decision curve analysis yielded a range of threshold probabilities (0.014-0.779) at which the clinical net benefit of the risk model was greater than that in hypothetical all-screening or no-screening scenarios. CONCLUSION: Our nomogram allows selection of a patient population at high risk for cancer-specific mortality and thus facilitates the design of prevention trials for the affected population.