Prognostic factors in patients with unresectable locally advanced pancreatic adenocarcinoma treated with chemoradiation

University of Houston, Houston, Texas, United States
Cancer (Impact Factor: 4.89). 12/2006; 107(11):2589 - 2596. DOI: 10.1002/cncr.22328

ABSTRACT Although patients with locally advanced pancreatic cancer (LAPC) have an extremely poor prognosis, they are a heterogeneous group. Prognostic factors are inadequately defined for disease-free survival and overall survival in patients with LAPC who are receiving chemoradiation, so more definitive prognostic factors would be very useful for designing clinical trials. Between December 1993 and July 2005, 247 patients with nonmetastatic LAPC were treated at M. D. Anderson Cancer Center (Houston, Tex) with concurrent chemoradiation (CRT). Median radiation dose was 30 Gy (range, 15–52.2 Gy). Radiosensitizers included 5-fluorouracil (54%), gemcitabine (33%), and capecitabine (13%). Actuarial univariate and multivariate statistical methods were used to determine significant prognostic factors for disease-free survival and overall survival. Median follow-up was 4.3 months (range, 1–63 months). Median disease-free survival and overall survival were 4.2 months and 8.5 months, respectively. On univariate analysis, prognostic factors for improved disease-free survival were a Karnofsky performance scale (KPS) status of >80 (P < .01) and a hemoglobin (Hgb)level at presentation of ≥12 (P = .03). On multivariate analysis, KPS was the only independent prognostic factor for disease-free survival. Median disease-free survival was 4.9 months among patients with a KPS score of >80 and was 3.9 months among those with a KPS score of ≤80. On univariate analysis, prognostic factors for improved overall survival were an Hgb level of ≥12 (P = .02), KPS>80 (P < .001), and <5% weight loss (P = .03). On multivariate analysis, Hgb and KPS were independent prognostic factors for overall survival. In the current study, KPS score was an independent prognostic factor for disease-free and overall survival among patients treated with chemoradiation for LAPC. The pretreatment Hgb level was an additional independent prognostic factor for overall survival. Cancer 2006.

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Available from: James L Abbruzzese, Dec 29, 2014
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    • "p=0.02 and p=0.009 respectively). Numerous studies have reported a strong independent prognostic importance of PS in all cancer patients (Tammemagi et al., 2003; Mitry et al., 2004; Krishnan et al., 2006). The significance of PS was also confirmed in SCLC patients (Foster et al., 2009). "
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    • "Among patients with metastatic ASC, patients who received chemotherapy had a longer overall survival duration (4.5 vs 2 months) than patients who did not. The significance of this finding is uncertain, however, because individual performance status—the most influential factor with regard to the administration of anticancer therapy among patients with advanced pancreatic malignancy—was not recorded in the CCR.46 The absence of recorded performance status represents a fundamental limitation of this and other analyses of pancreatic malignancies using large, population-based datasets. "
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    • "Unfortunately, CT scan, as well as endoscopic ultrasonography, cannot distinguish remnant tumour tissue from a chemoradiotherapy-induced fibrous reaction surrounding or directly touching the adjacent arteries, even in case of a complete tumour response [12]. Therefore, in the absence of distant metastases, surgical resection is decided exclusively based on performance status, CA 19-9 plasma level and a decrease in the size of the pancreatic mass with the consequent risk of performing a pancreatic resection with positive margins [6] [7] [9] [11] [12] [14] [15]. In our opinion, multiple intraoperative sampling of the area surrounding the initially encased artery is essential to determine the pathological response to chemoradiotherapy of locally advanced tumours amenable to radical surgery. "
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