title: Survival analysis of veteran patients with pancreatic cancer.
abstract: OBJECTIVE
  For patients with pancreatic cancer, the identification of reliable predictors of their outcomes could be invaluable for directing the managements. This study aimed to identify clinical and laboratory factors that could be used to predict early (≤6 months) or late (>6 months) mortality.
  
  
  METHODS
  Medical records of patients diagnosed with pancreatic cancer in the VA North Texas Health Care System from 2005 to 2010 were retrospectively reviewed. Univariate and multivariate analyses (MVA) were performed and the utility of cancer antigen 19-9 (CA19-9) test was explored.
  
  
  RESULTS
  Altogether 109 patients with pancreatic cancer, 89.0% of whom were with adenocarcinoma, were divided into early (n = 62) and late (n = 47) mortality groups. Kaplan-Meier analysis revealed a median survival of 154 days [95% confidence interval (CI) 93-194 days]. On MVA, abdominal pain (OR = 10.6, P = 0.009) and large tumor size (OR = 2.4, P = 0.028) were significantly associated with early mortality, while palliative chemotherapy (OR = 0.048, P = 0.001) and neuroendocrine tumor (OR = 0.009, P = 0.024) were significantly associated with late mortality. Subgroup analyses of adenocarcinoma and late-stage patients revealed similar results. Serum CA19-9 performed poorly as a prognostic indicator in both groups (P = 0.43), in metastatic disease at diagnosis (P = 0.32) and after treatment (P = 0.65).
  
  
  CONCLUSIONS
  Abdominal pain and large tumor size portends a poor prognosis in patients with pancreatic cancer. Palliative chemotherapy and surgical intervention may prolong the patient's survival. CA19-9 is not universally reliable for predicting metastasis, survival, or the responses to chemotherapy.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas Texas, USA.
authors.forename: David
authors.identifier: http://orcid.org/0000-0001-5714-3262
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Clinical Science, Simmons Cancer Center, University of Texas Southwestern Medical Center at Dallas, Dallas Texas, USA.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas Texas, USA.
authors.forename: Ammar
authors.initials: A
authors.lastname: Nassri
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center at Dallas.
authors.forename: Ali
authors.initials: A
authors.lastname: Mokdad
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center at Dallas.
authors.forename: Sachin
authors.initials: S
authors.lastname: Kukreja
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center at Dallas.
authors.forename: Patricio
authors.initials: P
authors.lastname: Polanco
authors.affiliation: Department of Surgery, VA North Texas Health Care System.
authors.forename: Sergio
authors.initials: S
authors.lastname: Huerta
authors.affiliation: Department of Internal Medicine, Gastroenterology Division, VA North Texas Health Care System.
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Ramzan
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000401:mortality; D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000368:Aged; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; D000970:Antineoplastic Agents; C578959:carbohydrate antigen 199, human
keywords: CA19-9 antigen; pancreatic adenocarcinoma; pancreatic neoplasms; predictor of mortality; veteran