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Clinical, laboratory parameters predict early pancreatic adenocarcinoma mortality
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Patients with pancreatic adenocarcinoma who had a high Khorana score or elevated blood urea nitrogen at baseline demonstrated a significantly greater risk for mortality within 6 months after surgical resection, according to study results.
Davendra P.S. Sohal, MD, MPH, of the department of hematology and medical oncology at Taussig Cancer Institute at Cleveland Clinic, and colleagues evaluated data from 334 patients who underwent surgical resection for pancreatic cancer between 2006 and 2013. The median age of the population was 67 years; 50% of the cohort was female and 86% were non-Hispanic white.
Davendra P.S. Sohal
The pancreatic head was the most common primary tumor site (73%). The majority of patients had tumors classified as T3 (67%) and N1 (63%).
The cohort’s median Khorana score — a venous thromboembolism risk score — was 2. Nearly half (47%) of patients had a score of 3 or greater, classified as a high-risk score.
Seventy percent of patients underwent adjunctive chemotherapy and 40% underwent adjunctive radiation therapy.
After a median follow-up of 39.4 months, 205 patients (61%) had died. Three patients died within 30 days of surgical resection, and 29 patients died by 180 days.
Median OS was 21.3 months.
The 6-month mortality rate was significantly higher among patients with a high-risk Khorana score (13.4% vs. 5.6%; P = .02). Results of a multivariate analysis indicated the risk for early mortality was significantly greater among patients with a high Khorana score (HR = 2.32; 95% CI, 1.04-5.13), as well as in patients with blood urea nitrogen levels greater than 25 mg/dL (HR = 4.34; 95% CI, 1.84-10.25).
“The results of the current study demonstrate that a simple set of parameters available on every patient undergoing routine clinical care may help to identify patients at high risk of early mortality from resectable pancreatic adenocarcinoma,” Sohal and colleagues wrote. “With a growing trend toward preoperative therapies for resectable and borderline resectable pancreatic cancer at the study institution as well as others, there is an opportunity for prospective studies focusing on this subgroup of high-risk patients to validate these findings. Calculation of this score at baseline may be used to stratify patients, and ultimately may be used to select high-risk patients for more aggressive therapies in prospective studies.” – by Alexandra Todak
Disclosure: One researcher reports receiving personal fees from AngioDynamics, Boehringer Ingelheim, Genentech, Halozyme Therapeutics, Janssen, Leo Pharma and Pfizer.
Perspective
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Philip Agop Philip, MD, PhD, FRCP
In this retrospective analysis of 334 patients, Sohal and colleagues investigated factors that predict early mortality after radical resection of pancreatic adenocarcinoma. The Khorana index was used to define patients at high risk (> 3). They report that baseline clinical and laboratory parameters can be used to risk-stratify patients. High-risk patients had a 13.4% risk for early death after surgery. However, their data did not provide the percentage of deaths due to cancer progression.Despite limitations of a retrospective study and heterogeneity of pre- and postoperative anti-cancer treatments, this study has important practical implications regarding the management of resectable pancreatic cancer. It reinforces the value of identifying high-risk patients for careful preoperative assessment and determination of benefit vs. risk. Examples include older patients with multiple comorbidities. It also supports the longstanding notion that radical pancreatic resections must be performed at centers that have high levels of operative skills and postoperative care.
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