A proposed model for prediction of survival based on a follow-up study in unresectable pancreatic cancer

Abstract

ObjectivesTo define an easy-to-use model for prediction of survival time in patients with unresectable pancreatic cancer in order to optimise patient' care.DesignAn observational retrospective study on patients with unresectable pancreatic cancer. The initial radiographs at presentation of symptoms were reviewed and the maximum diameter of the primary tumour was determined. The occurrence of liver metastases and performance status that determines initiation of chemotherapy was also used in the regression analysis to identify prognostic subgroups.SettingCounty hospital in south-east of Sweden.PopulationConsecutive patients with unresectable pancreatic cancer who were diagnosed between January 2003 and May 2010 (n=132).Main outcome measuresStatistical analyses were performed using Stata V.13. Survival time was assessed with Kaplan-Meier analysis, log-rank test for equality of survivor functions and Cox regression for calculation of individual hazard based on tumour diameter, presence of liver metastases and initiation of chemotherapy treatment according to patient performance status.ResultsThe individual hazard was log h=0.357 tumour size+1.181 liver metastases−0.989 performance status/chemotherapy. Three prognostic groups could be defined: a low-risk group with a median survival time of 6.7 (IQR 9.7) months, a medium-risk group with a median survival time of 4.5 (IQR 4.5) months and a high-risk group with a median survival time of 1.2 (IQR 1.7) months.ConclusionsThe maximum diameter of the primary tumour and the presence of liver metastases found at the X-ray examination of patients with pancreatic cancer, in conjunction with whether or not chemotherapy is initiated according to performance status, predict the survival time for patients who do not undergo surgical resection. The findings result in an easy-to-use model for predicting the survival time.

Indications for staging laparoscopy in pancreatic cancer

“…Tumour size is one of the most important staging criteria and prognostic indicators in pancreatic cancer. [53][54][55][56][57][58] Studies have shown increased tumour size is associated with metastases not identified on pre-operative CT. Yoshida et al reported patients with resectable disease at laparotomy had a mean tumour size of 3.1 cm, compared to 4.4 cm in patients with metastatic disease (p < 0.005). 59 Similarly, Morganti and co-workers observed patients (n = 54) with a tumour size >3 cm had significantly more metastases at exploration compared to patients with tumours <3 cm (22% versus 0%, respectively; p < 0.01).…”

SOURCE-PANC: A Prediction Model for Patients With Metastatic Pancreatic Ductal Adenocarcinoma Based on Nationwide Population-Based Data

“…In PDAC, these models have been focused mainly on patients with localized disease. [8][9][10][11][12][13][14] The limited number of models that included patients with advanced disease were based on a small number of patients, 15 developed for specific patient groups (eg, patients after firstline systemic treatment 16 or treated with gemcitabine-based regimens [17][18][19] ), based on patients included in trials only, 19,20 limited to patients with locally advanced disease, 17,21 or only described together with patients with localized diasease. 22 Moreover, they all did not take into account the different palliative systemic treatment options that are currently available for PDAC.…”

Serum interleukin-6 is associated with pancreatic ductal adenocarcinoma progression pattern

“…[ 7 ] Several studies showed that the presence of hepatic metastasis is an independent adverse prognostic factor in patients with metastatic PDAC. [ 8 – 10 ] Recently, 1 autopsy study for patterns of failure in patients with PDAC suggested that it is classified to limited versus extensive metastasis according to the tumor burden in the metastatic setting. [ 11 ] Some studies showed that increased IL-6 or IL-8 serum level is associated with the presence of hepatic metastasis and shorter survival in patients with PDAC.…”