title: McGill Brisbane Symptom Score for patients with resectable pancreatic head adenocarcinoma.
abstract: OBJECTIVE
  To evaluate the ability of the McGill Brisbane Symptom Score (MBSS) to predict survival in resectable pancreatic head adenocarcinoma (PHA) patients.
  
  
  METHODS
  All PHA patients (n = 83) undergoing pancreaticoduodenectomy at the McGill University Health Center, Quebec between 1/2001-1/2010 were evaluated. Data related to patient and cancer characteristics, MBSS variables, and treatment were collected; univariable and multivariable survival analyses were performed. We obtained complete follow-up until February 2011 in all patients through the database of the provincial health insurance plan of Quebec. The unique health insurance numbers of these patients were used to retrieve information from this database which captures all billable clinical encounters, and ensures 100% actual survival data.
  
  
  RESULTS
  Median survival was 23 mo overall: 45 mo for patients with low MBSS, 17 mo for high MBSS (P = 0.005). At twelve months survival was 83.3% (95%CI: 66.6-92.1) vs 58.1% (95%CI: 42.1-71.2) in those with low vs high MBSS, and 24 mo survival was 63.8% (95%CI: 45.9-77.1) and 34.0% (95%CI: 20.2-48.2) respectively. In the multivariate Cox model (stratified by chemotherapy), after addition of clinically meaningful covariates, MBSS was the variable with the strongest association with survival (HR = 2.63; P = 0.001). Adjuvant chemotherapy interacted with MBSS category such that only high MBSS patients accrued a benefit. In univariate analysis we found a lower mortality in high MBSS but not low MBSS patients receiving adjuvant chemotherapy. This interaction variable, on Cox model, resulted in an adjusted mortality HR for the high MBSS (compared to low MBSS) of 4.14 (95%CI: 1.48-11.64) without chemotherapy and 2.11 (95%CI: 1.06-4.17) with chemotherapy.
  
  
  CONCLUSIONS
  The MBSS is a simple prognostic tool for resectable PHA. Preoperative categorization of patients according to the MBSS allows effective stratification of patients to guide therapy.
authors.affiliation: Mohammed H Jamal, Sinziana Dumitra, Jad abou Khalil, Eve Simoneau, Prosanto Chaudhury, Peter Metrakos, Jeffrey S Barkun, Hepato-biliary, Pancreatic and Liver Transplant Surgery, McGill University Health Center, Montreal QCH3A 1A1, Canada.
authors.forename: Mohammed H
authors.initials: MH
authors.lastname: Jamal
authors.affiliation: Mohammed H Jamal, Sinziana Dumitra, Jad abou Khalil, Eve Simoneau, Prosanto Chaudhury, Peter Metrakos, Jeffrey S Barkun, Hepato-biliary, Pancreatic and Liver Transplant Surgery, McGill University Health Center, Montreal QCH3A 1A1, Canada.
authors.forename: Suhail A R
authors.initials: SA
authors.lastname: Doi
authors.affiliation: Mohammed H Jamal, Sinziana Dumitra, Jad abou Khalil, Eve Simoneau, Prosanto Chaudhury, Peter Metrakos, Jeffrey S Barkun, Hepato-biliary, Pancreatic and Liver Transplant Surgery, McGill University Health Center, Montreal QCH3A 1A1, Canada.
authors.forename: A James
authors.initials: AJ
authors.lastname: Moser
authors.affiliation: Mohammed H Jamal, Sinziana Dumitra, Jad abou Khalil, Eve Simoneau, Prosanto Chaudhury, Peter Metrakos, Jeffrey S Barkun, Hepato-biliary, Pancreatic and Liver Transplant Surgery, McGill University Health Center, Montreal QCH3A 1A1, Canada.
authors.forename: Sinziana
authors.initials: S
authors.lastname: Dumitra
authors.affiliation: Mohammed H Jamal, Sinziana Dumitra, Jad abou Khalil, Eve Simoneau, Prosanto Chaudhury, Peter Metrakos, Jeffrey S Barkun, Hepato-biliary, Pancreatic and Liver Transplant Surgery, McGill University Health Center, Montreal QCH3A 1A1, Canada.
authors.forename: Jad
authors.initials: J
authors.lastname: abou Khalil
authors.affiliation: Mohammed H Jamal, Sinziana Dumitra, Jad abou Khalil, Eve Simoneau, Prosanto Chaudhury, Peter Metrakos, Jeffrey S Barkun, Hepato-biliary, Pancreatic and Liver Transplant Surgery, McGill University Health Center, Montreal QCH3A 1A1, Canada.
authors.forename: Eve
authors.initials: E
authors.lastname: Simoneau
authors.affiliation: Mohammed H Jamal, Sinziana Dumitra, Jad abou Khalil, Eve Simoneau, Prosanto Chaudhury, Peter Metrakos, Jeffrey S Barkun, Hepato-biliary, Pancreatic and Liver Transplant Surgery, McGill University Health Center, Montreal QCH3A 1A1, Canada.
authors.forename: Prosanto
authors.initials: P
authors.lastname: Chaudhury
authors.affiliation: Mohammed H Jamal, Sinziana Dumitra, Jad abou Khalil, Eve Simoneau, Prosanto Chaudhury, Peter Metrakos, Jeffrey S Barkun, Hepato-biliary, Pancreatic and Liver Transplant Surgery, McGill University Health Center, Montreal QCH3A 1A1, Canada.
authors.forename: Adedayo A
authors.initials: AA
authors.lastname: Onitilo
authors.affiliation: Mohammed H Jamal, Sinziana Dumitra, Jad abou Khalil, Eve Simoneau, Prosanto Chaudhury, Peter Metrakos, Jeffrey S Barkun, Hepato-biliary, Pancreatic and Liver Transplant Surgery, McGill University Health Center, Montreal QCH3A 1A1, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Metrakos
authors.affiliation: Mohammed H Jamal, Sinziana Dumitra, Jad abou Khalil, Eve Simoneau, Prosanto Chaudhury, Peter Metrakos, Jeffrey S Barkun, Hepato-biliary, Pancreatic and Liver Transplant Surgery, McGill University Health Center, Montreal QCH3A 1A1, Canada.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Barkun
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; 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; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chemotherapy; Pancreatic adenocarcinoma; Pancreatic neoplasms; Prognosis; Survival study; Whipple procedure