title: Impact of Comorbidity and Age on Determinants Therapeutic Strategies in Advanced Pancreatic Head Cancer Patients With Obstructive Jaundices.
abstract: The current retrospective study aimed to investigate the relationship between prognostic factors and overall survival (OS) in patients with advanced pancreatic head cancers who initially presented with obstructive jaundice. Furthermore, the impact of age and comorbidities on therapeutic strategies in such patients was evaluated.A total of 79 advanced pancreatic head cancer patients who were treated at our institution between January 2006 and November 2013 were reviewed. We analyzed OS risk factors including sex, age, laboratory characteristics, Eastern Cooperative Oncology Group performance status, Charlson Comorbidity Index Scores (CCIS), and therapeutic strategies using Cox proportional hazards regression models.There was no difference in the OS of patients according to the type biliary drainage procedure they underwent. Other related factors, such as better performance status, lower CCIS, and receiving chemotherapy significantly correlated with survival in multivariate analyses. There was a significant survival benefit in systemic chemotherapy compared to best supportive care (BSC) or local radiotherapy. However, no survival benefit was found in elderly patients (age >70 years) undergoing systemic therapy compared to younger patients, except in those elderly patients with CCIS ≤ 1.In advanced pancreatic head cancer patients with obstructive jaundice, systemic therapy and adequate biliary drainage were still the most effective procedures for improving OS in the general population. However, in elderly patients with relatively higher CCIS, BSC with adequate biliary drainage was palliative and no less effective than systemic/local therapies.
authors.affiliation: From the Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC (Y-GC, M-SD, C-SL, P-YC, T-CH, J-HC, Y-YW, Y-CC, CLH); Department of Nursing, Tri-Service General Hospital; School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC (H-HP); Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC (CL, SLS); School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC (S-LS); and Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC (C-SL).
authors.forename: Yu-Guang
authors.initials: YG
authors.lastname: Chen
authors.forename: Hsueh-Hsing
authors.initials: HH
authors.lastname: Pan
authors.forename: Ming-Shen
authors.initials: MS
authors.lastname: Dai
authors.forename: Chin
authors.initials: C
authors.lastname: Lin
authors.forename: Chieh-Sheng
authors.initials: CS
authors.lastname: Lu
authors.forename: Sui-Lung
authors.initials: SL
authors.lastname: Su
authors.forename: Ping-Ying
authors.initials: PY
authors.lastname: Chang
authors.forename: Tzu-Chuan
authors.initials: TC
authors.lastname: Huang
authors.forename: Jia-Hong
authors.initials: JH
authors.lastname: Chen
authors.forename: Yi-Ying
authors.initials: YY
authors.lastname: Wu
authors.forename: Yeu-Chin
authors.initials: YC
authors.lastname: Chen
authors.forename: Ching Liang
authors.initials: CL
authors.lastname: Ho
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome