Predicting early mortality in resectable pancreatic adenocarcinoma: A cohort study

Abstract

BACKGROUND: Survival after surgical resection for pancreatic cancer remains poor. A subgroup of patients die early (<6 months), and understanding factors associated with early mortality may help to identify high-risk patients. The Khorana score has been shown to be associated with early mortality for patients with solid tumors. In the current study, the authors evaluated the role of this score and other prognostic variables in this setting. METHODS: The current study was a cohort study of patients who underwent surgical resection for pancreatic cancer from January 2006 through June 2013. Baseline (diagnosis 630 days) parameters were used to define patients as high risk (Khorana score 3). Statistically significant univariable associations and a priori prognostic variables were tested in multivariable models; adjusted hazard ratios (HR) were calculated. RESULTS: The study population comprised 334 patients. The median age was 67 years, 50% of the study population was female, and 86% of the patients were white. The pancreatic head was the primary tumor site for 73% of patients; 67% of tumors were T3 and 63% were N1. The median Khorana score was 2; 152 patients (47%) were determined to be high risk. Adjunctive treatment included chemotherapy (70%) and radiotherapy (40%). The postoperative (30-day) mortality rate was 0.9%. The 6-month mortality rate for the entire cohort was 9.4%, with significantly higher rates observed for high-risk patients (13.4% vs 5.6%; P 5.02). On multivariable analyses (examining a total of 326 patients), the Khorana score (HR for high risk, 2.31; P 5.039) and elevated blood urea nitrogen (HR, 4.34; P<.001) were associated with early mortality. CONCLUSIONS: Patients at high risk of early mortality after surgical resection of pancreatic adenocarcinoma can be identified using simple baseline clinical and laboratory parameters. Future studies should address preoperative interventions in these patients at high risk of early mortality.

Performance of Khorana Risk Score for Prediction of Venous Thromboembolism in Patients With Hepatocellular Carcinoma

“…Kuderer et al retrospectively analyzed the 4405 patients involved in the original Khorana study and concluded KRS could predict early mortality (<120 days) and cancer progression. 14 In their cohort of resectable pancreatic adenocarcinoma, Sohal et al 13 also reported KRS was associated with early mortality (within 30 days), which is in line with the findings in lung cancer. 9 In the present cohort, however, KRS >0 was not associated with higher mortality in multivariate analysis.…”

“…10 A modification of the KRS was externally validated in Vienna Cancer and Thrombosis Study 11 ; however, in subsequent cohorts of specific cancer types, the score has been challenged and deserves retesting. 9,12,13 In addition, it has been suggested that the KRS may add information on the prediction of mortality, 14 and this has not been tested in patients with hepatocellular carcinoma (HCC).…”

Predictors of active cancer thromboembolic outcomes: validation of the Khorana score among patients with lung cancer

“…We are not the first to describe the KRS as a potential predictor of mortality. In a study of patients with pancreatic cancer, patients with a high KRS were more likely to die within 6 months (HR, 2.5; 95% CI, 1.1–2.1) . Similarly, in a prospective cohort of 1544 patients with different types of cancer the KRS was associated with risk of death (HR per increase of 1 point within the KRS, 1.6; 95% CI, 1.45–1.68).…”

Preoperative predictors for early recurrence of resectable pancreatic cancer

“…However, some researchers found that median OS of patients with RPC was approximately 12 months after surgery alone [9]. Other researchers found that the median OS of patients with RPC was <2 years after surgery and adjuvant therapy [10, 11]. Furthermore, at least 25% of patients cannot receive adjuvant chemotherapy because of complications related to surgery [9].…”