title: Unresectable pancreatic adenocarcinoma: do we know who survives?
abstract: BACKGROUND
  This study attempts to define clinical predictors of survival in patients with unresectable pancreatic adenocarcinoma (UPA).
  
  
  METHODS
  A retrospective study of 94 consecutive patients diagnosed with UPA from 2001 to 2006 was performed. Using data for these patients, a symptom score was devised through a forward stepwise Cox proportional hazards model based on four weighted criteria: weight loss of >10% of body weight; pain; jaundice, and smoking. The symptom score was subsequently validated in a distinct cohort of 32 patients diagnosed with UPA in 2007.
  
  
  RESULTS
  In the original cohort, the overall median survival was 9.0 months (95% confidence interval [CI] 7.6-10.4). This altered to 10.3 months (95% CI 6.1-14.5) in patients with locally advanced disease, and 6.6 months (95% CI 4.2-9.0) in patients with distant metastasis. Median survival was 14.6 months (95% CI 13.1-16.1) in patients with a low symptom (LS) score and 6.3 months (95% CI 4.1-8.5) in patients with a high symptom (HS) score. A total of 73% of LS score patients survived beyond 9 months, compared with only 38% of HS score patients (P<0.001). The discrimination of the LS score was greater than that of any conventional method, including imaging. The validation cohort confirmed the discriminative ability of the symptom score for survival.
  
  
  CONCLUSIONS
  A simple and clinically meaningful point-based symptom score can successfully predict survival in patients with UPA.
authors.affiliation: Department of Surgery, McGill University Health Center, Montreal, QC, Canada.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Jamal
authors.forename: Suhail A
authors.initials: SA
authors.lastname: Doi
authors.forename: Eve
authors.initials: E
authors.lastname: Simoneau
authors.forename: Jad
authors.initials: J
authors.lastname: Abou Khalil
authors.forename: Mazen
authors.initials: M
authors.lastname: Hassanain
authors.forename: Prosanto
authors.initials: P
authors.lastname: Chaudhury
authors.forename: Jean
authors.initials: J
authors.lastname: Tchervenkov
authors.forename: Peter
authors.initials: P
authors.lastname: Metrakos
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Barkun
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007565:Jaundice / Q000401:mortality; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain / Q000401:mortality; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D016016:Proportional Hazards Models; D011792:Quebec / Q000453:epidemiology; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss