A new preoperative prognostic scoring system to predict prognosis in patients with locally advanced pancreatic body cancer who undergo distal pancreatectomy with en bloc celiac axis resection: a retrospective cohort study.
BACKGROUND
Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) provides good local control for locally advanced pancreatic body cancer, but early recurrence still occurs. In this study, we aimed to establish a new scoring system to predict prognosis using preoperative factors in patients with locally advanced pancreatic body cancer who undergo DP-CAR.


METHODS
Prognostic factors were analyzed using various data collected retrospectively from 50 consecutive patients who underwent DP-CAR. Using these preoperative factors, a scoring system to predict prognosis was established.


RESULTS
Multivariate analysis identified intraoperative blood loss (≥940 mL; hazard ratio [HR], 25.179; P = .0003), preoperative platelet counts (<150 × 10(9)/L; HR, 7.433; P = .0043), preoperative C-reactive protein (CRP) levels (≥0.4 mg/dL; HR, 7.064; P = .0018), and preoperative carbohydrate antigen 19-9 (CA19-9) levels (≥300 U/mL; HR, 8.197; P = .0053) as independent adverse prognostic factors. For the 3 preoperative factors, preoperative platelet counts <150 × 10(9)/L, preoperative CRP levels ≥0.4 mg/dL, and preoperative CA19-9 levels ≥300 U/mL were allocated 1 point each. The total score was defined as the Preoperative Prognostic Score (PPS). The estimated disease-specific 1- and 5-year survival rates for the 26 patients with PPS0 were 95.7%, and 49.1%, respectively, and for the 15 patients with PPS1, they were 86.7% and not available, respectively. The median survival times for PPS0 and PPS1 were 50.6 and 22.3 months, respectively. In contrast, in the 9 patients with PPS2/3, 1- and 5-year survival rates were 33.3% and 0%, respectively, and median survival time was only 7.7 months.


CONCLUSIONS
A new prognostic scoring system using the preoperative platelet count, CRP, and CA19-9 enables preoperative prediction of prognosis and facilitates selection of appropriate treatment for borderline resectable cases of locally advanced pancreatic body cancer.
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan. Electronic address: taku-miu20@feel.ocn.ne.jp.
Takumi
T
Miura
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Satoshi
S
Hirano
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Toru
T
Nakamura
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Eiichi
E
Tanaka
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Toshiaki
T
Shichinohe
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Takahiro
T
Tsuchikawa
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Kentaro
K
Kato
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Joe
J
Matsumoto
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Satoshi
S
Kondo
D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods*; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis