title: Postoperative Serum Albumin Level is a Marker of Incomplete Adjuvant Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma.
abstract: BACKGROUND
  Adjuvant chemotherapy (AC) is recommended as a standard treatment after curative resection in patients with pancreatic adenocarcinoma (PA). Although patients who failed to complete AC had significantly worse survival compared with those who completed AC for cancers in various organs, the effects of complete AC on survival in patients with PA have not been investigated. The purpose of this study was to clarify the impact of complete AC on PA patient survival and to identify independent risk factors for incomplete AC.
  
  
  METHODS
  Medical records of 236 consecutive PA patients who planned to undergo surgical resection with curative intent between January 2000 and September 2012 at Kobe University Hospital were retrospectively reviewed. Of these, the complete AC (n = 75) and the incomplete AC (n = 30) groups due to adverse events were compared.
  
  
  RESULTS
  Patient survival was significantly better in the complete AC group than in the incomplete AC group (median survival time 48.9 vs. 17.9 months; 5-year survival rate 42.7 vs. 17.1 %; p < 0.0001). Preoperative white blood cell count and postoperative serum albumin level were identified as independent risk factors for incomplete AC. By receiver operating characteristic curve analysis, the cutoff value of postoperative serum albumin level was 3.1 mg/dL.
  
  
  CONCLUSIONS
  PA patients who completed AC had significantly better survival than those who failed to complete AC. Postoperative serum albumin level is a marker for failure to complete AC. Further prospective studies are needed to determine whether perioperative nutritional intervention could increase AC completion rate and improve prognosis in PA patients.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan, ippeimm@gmail.com.
authors.forename: Ippei
authors.initials: I
authors.lastname: Matsumoto
authors.forename: Masaki
authors.initials: M
authors.lastname: Tanaka
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Shirakawa
authors.forename: Makoto
authors.initials: M
authors.lastname: Shinzeki
authors.forename: Hirochika
authors.initials: H
authors.lastname: Toyama
authors.forename: Sadaki
authors.initials: S
authors.lastname: Asari
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Goto
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamashita
authors.forename: Jun
authors.initials: J
authors.lastname: Ishida
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ajiki
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Shimokawa
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015415:Biomarkers / Q000378:metabolism*; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism*; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D012709:Serum Albumin