title: Jaundice: an important, poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas.
abstract: OBJECTIVE
  Jaundice impairs cellular immunity, an important defence against the dissemination of cancer. Jaundice is a common mode of presentation in pancreatic head adenocarcinoma. The purpose of this study was to determine whether there is an association between preoperative jaundice and survival in patients who have undergone resection of such tumours.
  
  
  METHODS
  Thirty possible survival risk factors were evaluated in a database of over 400 resected patients. Univariate analysis was used to determine odds ratio for death. All factors for which a P-value of <0.30 was obtained were entered into a multivariate analysis using the Cox model with backward selection.
  
  
  RESULTS
  Preoperative jaundice, age, positive node status, poor differentiation and lymphatic invasion were significant indicators of poor outcome in multivariate analysis. Absence of jaundice was a highly favourable prognostic factor. Interaction emerged between jaundice and nodal status. The benefit conferred by the absence of jaundice was restricted to patients in whom negative node status was present. Five-year overall survival in this group was 66%. Jaundiced patients who underwent preoperative stenting had a survival advantage.
  
  
  CONCLUSIONS
  Preoperative jaundice is a negative risk factor in adenocarcinoma of the pancreas. Additional studies are required to determine the exact mechanism for this effect.
authors.affiliation: Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Washington University in St Louis, St Louis, MO, USA; Alvin J. Siteman Cancer Center, Washington University in St Louis, St Louis, MO, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Dominic
authors.initials: D
authors.lastname: Sanford
authors.forename: David C
authors.initials: DC
authors.lastname: Linehan
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
authors.forename: Ryan
authors.initials: R
authors.lastname: Fields
authors.forename: Danielle H
authors.initials: DH
authors.lastname: Carpenter
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Brunt
authors.forename: Carolyn
authors.initials: C
authors.lastname: Phillips
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome