title: Preoperative cognitive function predicts survival in patients with resectable pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  The purpose of this prospective study was to evaluate whether pre-surgery health-related quality of life (HRQoL) and subjectively rated symptom scores are prognostic factors for survival in patients with resectable pancreatic ductal adenocarcinoma (PDAC).
  
  
  METHODS
  Patients undergoing pancreatic resection for PDAC completed the Edmonton Symptom Assessment System (ESAS) and the EORTC QLQ-C30 and QLQ-PAN26 questionnaires preoperatively. Patient, tumor and treatment characteristics, recurrence and survival were registered.
  
  
  RESULTS
  Sixty-six consecutive patients underwent R0/R1 resection for PDAC. Baseline ESAS and EORTC questionnaire compliance was 44/66 (67%) with no statistically significant differences between compliers (n = 44) and non-compliers (n = 22) when comparing clinicopathological parameters and survival. Univariable analyses showed that three symptoms (nausea, dry mouth, cognitive function) and two clinicopathological factors (CA 19-9 > 400 U/ml, lymph node ratio > 0.1) were significantly associated with shorter survival (p < 0.05). In multivariable analysis, cognitive function was the only independent predictor for survival: hazard ratio = 0.35 (95%CI 0.13-0.93) for high vs low cognitive function. Median survival times for patients with high and low cognitive function were 21 and 10 months, respectively (p < 0.001).
  
  
  CONCLUSIONS
  Presurgery cognitive function is a significant independent predictor of survival in patients with resectable PDAC. Thus, presurgery patient reported outcomes may provide as strong prognostic information as clinicopathological factors.
authors.affiliation: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
authors.forename: Bart M G
authors.initials: BM
authors.lastname: Baekelandt
authors.affiliation: Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Norway; European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Hjermstad
authors.affiliation: Department of Gastroenterological Surgery, Østfold Hospital Trust, Norway.
authors.forename: Tom
authors.initials: T
authors.lastname: Nordby
authors.affiliation: Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Norway.
authors.forename: Morten W
authors.initials: MW
authors.lastname: Fagerland
authors.affiliation: Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.
authors.forename: Elin H
authors.initials: EH
authors.lastname: Kure
authors.affiliation: Østfold University College, Faculty of Health and Social Studies, Halden, Norway.
authors.forename: Turid
authors.initials: T
authors.lastname: Heiberg
authors.affiliation: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Norway.
authors.forename: Trond
authors.initials: T
authors.lastname: Buanes
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Norway. Electronic address: uxknab@ous-hf.no.
authors.forename: Knut J
authors.initials: KJ
authors.lastname: Labori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome