Prognostic factors in nonresectable pancreatic adenocarcinoma: a rationale to design therapeutic trials.
OBJECTIVE
Most patients with pancreatic cancer show an advanced tumor at the time of diagnosis. In recent years, new therapies have been developed in such patients, thus forcing the analysis of factors that influence their survival. The present study was aimed at determining the prognostic factors in a series of 134 consecutive patients with pancreatic carcinoma not suitable for surgical resection, due to either locally advanced tumors or metastatic spread.


METHODS
First, 34 epidemiological, clinical, analytical, and tumor-related parameters recruited at admission were included in a univariate analysis of survival by using the Kaplan-Meier method. Those significant variables in the previous step were thereafter introduced in a Cox regression procedure. A prognostic index for calculating the relative risk of death of each patient was also proposed.


RESULTS
The median survival time in the whole series was 3.11 months, the 3, 6, and 12 months probability of survival being 51%, 28%, and 8%, respectively. Eight of 34 variables (jaundice and toxic syndrome at admission, serum cholesterol, iron and alanine aminotransferase concentrations, leukocyte count, baseline performance status, and the presence of distant metastases) were selected in the univariate analysis. Of these eight parameters, the Cox regression analysis identified a preserved baseline performance status (OR = 2.14, 95% CI = 1.49-3.04) and the absence of metastases (OR = 1.34, 95% CI = 1.03-1.73) as the only variables independently associated with a longer survival. Therefore, a prognostic index was constructed allowing the division of patients in three different groups according to their relative risk of death (RRD) = exp (performance status x 0.7589 + presence of metastases x 0.2891).


CONCLUSIONS
The results of the present investigation suggest that baseline performance status and distant metastases should be considered in designing and evaluating any therapeutic trial in patients with nonresectable pancreatic carcinoma.
Cubiella
J
J
Department of Gastroenterology, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona, Catalonia, Spain.
Castells
A
A
Fondevila
C
C
Sans
M
M
Sabater
L
L
Navarro
S
S
Fernández-Cruz
L
L
D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D015233:Models, Statistical; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate