title: Predictors of Early Mortality After Surgical Resection of Pancreatic Adenocarcinoma in the Era of Neoadjuvant Treatment.
abstract: Neoadjuvant treatments are increasingly used for patients with pancreatic ductal adenocarcinoma (PDAC), yet some experience early mortality after resection. We sought to identify predictors of early mortality after PDAC resection and determine their interaction with neoadjuvant therapy.
  
  
  
  We performed a retrospective study of patients with PDAC resection from March 2011 to March 2014. We compared those who died within one year after surgery to those living beyond 1 year, and those who received neoadjuvant therapy to those taken directly to surgery. We used logistic regression to identify predictors of early mortality and determine their interaction with neoadjuvant therapy.
  
  
  
  Of 191 patients who underwent resection, 59 (30.9%) died within 1 year and 79 (41.4%) received neoadjuvant therapy. Early mortality patients were older, with higher comorbidity, and more likely to have lymph node positivity. Patients receiving neoadjuvant therapy were younger, with lower comorbidity, and more likely to have upfront unresectable disease. Predictors of early mortality included: higher comorbidity, poorly differentiated tumor grade, and lymph node positivity. We found that neoadjuvant therapy moderated the effects of comorbidity and lymph node positivity on early mortality risk.
  
  
  
  We identified predictors of early mortality after PDAC resection and determined their interaction with neoadjuvant therapy.
authors.affiliation: From the Departments of *Medical Oncology, †Surgery, ‡Biostatistics Center, and §Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Nipp
authors.forename: Andrea
authors.initials: A
authors.lastname: Zanconato
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Ferrone
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Wo
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Hong
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Clark
authors.forename: David P
authors.initials: DP
authors.lastname: Ryan
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernández-Del Castillo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate