Modeling prognostic factors in resectable pancreatic adenocarcinomas.
BACKGROUND
The accurate prognosis for patients with resectable pancreatic adenocarcinomas requires the incorporation of more factors than those included in AJCC TNM system.


METHODS
We identified 218 patients diagnosed with stage I and II pancreatic adenocarcinoma at NewYork-Presbyterian Hospital/Columbia University Medical Center (1999 to 2009). Tumor and clinical characteristics were retrieved and associations with survival were assessed by univariate Cox analysis. A multivariable model was constructed and a prognostic score was calculated; the prognostic strength of our model was assessed with the concordance index.


RESULTS
Our cohort had a median age of 67 years and consisted of 49% men; the median follow-up time was 14.3 months and the 5-year survival 3.6%. Age, tumor differentiation and size, alkaline phosphatase, albumin and CA 19-9 were the independent factors of the final multivariable model; patients were thus classified into low (n = 14, median survival = 53.7 months), intermediate (n = 124, median survival = 19.7 months) and high risk groups (n = 80, median survival = 12.3 months). The prognostic classification of our model remained significant after adjusting for adjuvant chemotherapy and the concordance index was 0.73 compared to 0.59 of the TNM system.


CONCLUSIONS
Our prognostic model was accurate in stratifying patients by risk and could be incorporated into clinical decisions.
Department of Biomedical Informatics, Columbia University, 10032 New York, USA.
Taxiarchis
T
Botsis
Valsamo K
VK
Anagnostou
Gunnar
G
Hartvigsen
George
G
Hripcsak
Chunhua
C
Weng