title: Prognostic model for survival based on readily available pretreatment factors in patients with advanced pancreatic cancer receiving palliative chemotherapy.
abstract: BACKGROUND
  We aimed to construct a prognostic model to predict survival in patients with advanced pancreatic cancer (APC) receiving palliative chemotherapy using readily available pretreatment factors.
  
  
  METHODS
  The model was constructed using data from 306 consecutive patients with APC who received palliative chemotherapy between January 2006 and March 2013. The predictive accuracy of the model was assessed using a concordance index (c-index) and calibration curves.
  
  
  RESULTS
  Among the 12 potential prognostic factors investigated, multivariate analysis identified the following six independent negative prognostic factors-performance status (PS), the presence of distant metastatic disease, the status of initially unresectable disease, carcinoembryonic antigen (CEA) level, carbohydrate antigen 19-9 (CA19-9) level, and neutrophil-lymphocyte ratio (NLR). A prognostic index (PI) based on the coefficients of these factors was constructed as follows-PI = 2 (if PS 2-3) + 1 (if distant metastatic disease) + 1 (if initially unresectable disease) + 1 (if CEA level ≥5.0 ng/ml) + 1 (if CA 19-9 level ≥1,000 U/ml) + 2 (if NLR ≥5). The patients were classified into three prognostic groups-favorable (PI 0-1, n = 73), intermediate (PI 2-3, n = 145), and poor (PI 4-8, n = 88). The median overall survival times for each prognostic group were 16.5, 12.3, and 6.2 months, respectively (P < 0.001). Bootstrapping verified the good fitness of this model for predicting 1-year survival, and the c-index was 0.658.
  
  
  CONCLUSIONS
  This simple prognostic model could help clinicians to estimate survival in patients with APC who receive palliative chemotherapy.
authors.affiliation: Digestive Disease Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimach, Kita-ku, Osaka, 530-8480, Japan. tadayuki.kou@gmail.com.
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Kou
authors.affiliation: Department of Clinical Oncology and Pharmacogenomics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kanai
authors.affiliation: Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Clinical Oncology and Pharmacogenomics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Peng
authors.initials: P
authors.lastname: Xue
authors.affiliation: Department of Translational Clinical Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Mori
authors.affiliation: Digestive Disease Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimach, Kita-ku, Osaka, 530-8480, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kudo
authors.affiliation: Digestive Disease Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimach, Kita-ku, Osaka, 530-8480, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kurita
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Norimitsu
authors.initials: N
authors.lastname: Uza
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Kodama
authors.affiliation: Digestive Disease Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimach, Kita-ku, Osaka, 530-8480, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Asada
authors.affiliation: Division of Hepatobiliary Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Michiya
authors.initials: M
authors.lastname: Kawaguchi
authors.affiliation: Division of Hepatobiliary Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Masui
authors.affiliation: Division of Hepatobiliary Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Mizumoto
authors.affiliation: Digestive Disease Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimach, Kita-ku, Osaka, 530-8480, Japan.
authors.forename: Shujiro
authors.initials: S
authors.lastname: Yazumi
authors.affiliation: Department of Clinical Oncology and Pharmacogenomics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shigemi
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Division of Hepatobiliary Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Takaori
authors.affiliation: Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morita
authors.affiliation: Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Muto
authors.affiliation: Division of Hepatobiliary Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Chiba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D005260:Female; D006304:Health Status; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009504:Neutrophils; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen
keywords: Palliative chemotherapy; Pancreatic cancer; Prognostic model