Prognostic factors in the palliation of pancreatic cancer.
OBJECTIVE
Few patients with pancreatic cancer are eligible for resection. In the remainder, estimation of prognosis is important to optimise various aspects of care, including palliation of biliary obstruction and trial of chemotherapy. The aim is to evaluate the prognostic significance of clinical and laboratory variables in patients with unresectable pancreatic cancer.


METHODS
Information was gathered retrospectively for 325 patients with unresectable pancreatic cancer who underwent palliative interventions, including surgical bypass, endoscopic or percutaneous stenting or who received supportive care only.


RESULTS
Histological proof was obtained in 182 patients (56%). Median survival was 5.7 months. Absence of therapeutic intervention, leukocytosis (WCC> or =11 x 10(9)/l), gamma glutamyl transferase (gamma GT)>165U/L, prothrombin time ratio > or =1.1, and C-reactive protein (CRP) > or = 5mg/dL were associated with shorter survival on univariate analysis. Only absence of therapeutic intervention, leukocytosis, and gamma GT>165 U/L reached significance on multivariate analysis. In the 51 patients in whom serum CRP was available, CRP was the only significant predictor of survival on multivariate analysis.


CONCLUSIONS
Leukocytosis, elevated gamma GT and raised CRP predict shorter survival and may help to guide the choice of palliative intervention for patients with unresectable pancreatic cancer.
Engelken
F J F
FJ
Department of Clinical and Surgical Sciences (Surgery), The University of Edinburgh, Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh, EH3 9YW, UK. R.W.Parks@ed.ac.uk
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Rahman
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Parks
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Garden
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D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D007964:Leukocytosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000201:enzymology / Q000473:pathology / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D011517:Prothrombin Time; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D005723:gamma-Glutamyltransferase / Q000097:blood
D002097:C-Reactive Protein; D005723:gamma-Glutamyltransferase