title: Predicting early mortality in resectable pancreatic adenocarcinoma: A cohort study.
abstract: BACKGROUND
  Survival after surgical resection for pancreatic cancer remains poor. A subgroup of patients die early (<6 months), and understanding factors associated with early mortality may help to identify high-risk patients. The Khorana score has been shown to be associated with early mortality for patients with solid tumors. In the current study, the authors evaluated the role of this score and other prognostic variables in this setting.
  
  
  METHODS
  The current study was a cohort study of patients who underwent surgical resection for pancreatic cancer from January 2006 through June 2013. Baseline (diagnosis ±30 days) parameters were used to define patients as high risk (Khorana score ≥3). Statistically significant univariable associations and a priori prognostic variables were tested in multivariable models; adjusted hazard ratios (HR) were calculated.
  
  
  RESULTS
  The study population comprised 334 patients. The median age was 67 years, 50% of the study population was female, and 86% of the patients were white. The pancreatic head was the primary tumor site for 73% of patients; 67% of tumors were T3 and 63% were N1. The median Khorana score was 2; 152 patients (47%) were determined to be high risk. Adjunctive treatment included chemotherapy (70%) and radiotherapy (40%). The postoperative (30-day) mortality rate was 0.9%. The 6-month mortality rate for the entire cohort was 9.4%, with significantly higher rates observed for high-risk patients (13.4% vs 5.6%; P = .02). On multivariable analyses (examining a total of 326 patients), the Khorana score (HR for high risk, 2.31; P = .039) and elevated blood urea nitrogen (HR, 4.34; P<.001) were associated with early mortality.
  
  
  CONCLUSIONS
  Patients at high risk of early mortality after surgical resection of pancreatic adenocarcinoma can be identified using simple baseline clinical and laboratory parameters. Future studies should address preoperative interventions in these patients at high risk of early mortality.
authors: Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Davendra P S
authors: DP
authors: Sohal
authors: Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Shiva
authors: S
authors: Shrotriya
authors: Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Kate Tullio
authors: KT
authors: Glass
authors: Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Robert J
authors: RJ
authors: Pelley
authors: Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Michael J
authors: MJ
authors: McNamara
authors: Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Bassam
authors: B
authors: Estfan
authors: Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Marc
authors: M
authors: Shapiro
authors: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Jane
authors: J
authors: Wey
authors: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Sricharan
authors: S
authors: Chalikonda
authors: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Gareth
authors: G
authors: Morris-Stiff
authors: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
authors: R Matthew
authors: RM
authors: Walsh
authors: Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Alok A
authors: AA
authors: Khorana
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
keywords: Khorana score; early mortality; pancreatic cancer; predictors