Early mortality risk score: identification of poor outcomes following upfront surgery for resectable pancreatic cancer.
BACKGROUND
Identifying pancreatic cancer patients at high risk of early mortality following pancreaticoduodenectomy (PD) is important for treatment decisions in a multidisciplinary setting. This study examines the preoperative predictors of early mortality following PD and combines these variables into an early mortality risk score (EMRS).


METHODS
Medical records of patients who underwent PD for pancreatic adenocarcinoma at the Johns Hopkins Hospital between 30 August 1993 and 28 February 2005 were reviewed. Cox proportional hazards analysis was performed to identify predictors of early mortality, defined as death at 9 and 12 months. EMRS was constructed from univariate associated risk factors (age >75 years, tumor size ≥ 3 cm, poor differentiation, co-morbid diseases) with each factor assigned 1 point (range of 0-4). EMRS was evaluated as an independent predictor of death at 9 and 12 months.


RESULTS
On univariate analysis, risk factors for death at 9 months included age ≥ 75 years (RR, 1.6; p = .009), comorbid disease (RR, 1.5; p = 0.020), tumor ≥ 3 cm (RR, 1.4; P = 0.050), and poor differentiation (RR, 2.1; P < 0.001). EMRS was associated with early mortality among those who did (p = 0.038) and did not receive adjuvant treatment (p < 0.001). A modified EMRS without tumor differentiation was also associated with early mortality (p < 0.001). Results persisted when reanalyzed using death at 12 months.


CONCLUSIONS
EMRS may identify patients at risk of early mortality following PD who may be candidates for alternatively sequenced treatment protocols. Prospective validation of this EMRS is needed.
The Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 410 North Broadway/Suite 1440, Baltimore, MD 21231-2410, USA.
Charles C
CC
Hsu
Christopher L
CL
Wolfgang
Daniel A
DA
Laheru
Timothy M
TM
Pawlik
Michael J
MJ
Swartz
Jordan M
JM
Winter
Raymond
R
Robinson
Barish H
BH
Edil
Amol K
AK
Narang
Michael A
MA
Choti
Ralph H
RH
Hruban
John L
JL
Cameron
Richard D
RD
Schulick
Joseph M
JM
Herman
D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D012307:Risk Factors; D047368:Tumor Burden