1. A Preoperative Prognostic Scoring System to Predict Prognosis for Resectable Pancreatic Cancer : Who Will Benefit from Upfront Surgery?
- Author
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1000070645796, Nakamura, Toru, Asano, Toshimichi, 1000090724401, Okamura, Keisuke, 1000050507572, Tsuchikawa, Takahiro, 1000080706573, Murakami, Soichi, 1000040374350, Kurashima, Yo, 1000050632981, Ebihara, Yuma, 1000010739296, Noji, Takehiro, 1000040447058, Nakanishi, Yoshitsugu, Tanaka, Kimitaka, 1000070374353, Shichinohe, Toshiaki, 1000050322813, Hirano, Satoshi, 1000070645796, Nakamura, Toru, Asano, Toshimichi, 1000090724401, Okamura, Keisuke, 1000050507572, Tsuchikawa, Takahiro, 1000080706573, Murakami, Soichi, 1000040374350, Kurashima, Yo, 1000050632981, Ebihara, Yuma, 1000010739296, Noji, Takehiro, 1000040447058, Nakanishi, Yoshitsugu, Tanaka, Kimitaka, 1000070374353, Shichinohe, Toshiaki, 1000050322813, and Hirano, Satoshi
- Abstract
Background: Upfront surgery is recommended in patients with potentially resectable pancreatic ductal adenocarcinoma (R-PDAC) by National Comprehensive Center Network (NCCN) guidelines. However, even among R-PDACs, there is a subset that demonstrates extremely poor prognosis. The purpose of this study was to identify preoperative prognostic factors for upfront surgical resection of R-PDACs. Methods: The records of 278 consecutive patients with PDAC who underwent curative resection between 2001 and 2015 in a single institution were retrospectively reviewed. Preoperative factors to predict prognosis in patients with R-PDAC according to the NCCN guidelines were analyzed. Results: Of the 278 patients who underwent resection, 153 R-PDACs received upfront surgery with a median survival time (MST) of 26.4months. Tumor location (pancreatic head) (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.14-3.40; P=0.015), preoperative cancer antigen 19-9 (CA19-9) >100U/mL (OR 1.92, 1.31-2.80; P=0.0009), and tumor size >20mm (OR 1.50, 1.02-2.19; P=0.038) were identified as preoperative independent predictive risk factors for poor prognosis in patients with R-PDACs. In the patients with R-PDAC, 5-year survival was 60.7%, 21.5%, and 0% in patients with 0, 1 or 2, and 3 risk factors, respectively. There were significant differences in overall survival between the three groups (P<.0001). Conclusions: A preoperative prognostic scoring system using preoperative tumor location, tumor size, and CA19-9 enables preoperative prediction of prognosis and facilitates selection of appropriate treatment for resectable pancreatic cancer.
- Published
- 2019