Gianpaolo Balzano1, Erica Dugnani2, Stefano Crippa1, Marina Scavini2, Valentina Pasquale2, Francesca Aleotti1, Daniela Liberati2, Alessandra Gandolfi2, Giulio Belfiori1, Michele Reni3, Claudio Doglioni4, Giacomo Ruffo5, Cristina Marmorale6, Massimo Falconi7, Lorenzo Piemonti8. 1. Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, Milan, Italy. 2. Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 3. Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy. 4. Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. 5. Division of General Surgery, Sacro Cuore Don Calabria Hospital, Verona, Italy. 6. Department of Surgery, Polytechnic University of Marche Region, Ancona, Italy. 7. Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. 8. Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: piemonti.lorenzo@hsr.it.
Abstract
BACKGROUND: This study aimed to develop and validate a preoperative prognostic model for death within one year post-surgery in patients with resectable pancreatic ductal adenocarcinoma (PDAC). METHODS: A derivation cohort study of 296 patients who underwent surgical resection of PDAC was prospectively enrolled in an observational study. Preoperative predictors of one year mortality were used to develop a risk score which was then validated in an external cohort of 182 patients with resectable PDAC. RESULTS: Seventy-eight out of 296 patients (26%) died within the first year. Preoperative independent predictors of one year mortality were: nutritional status (Geriatric Nutritional Risk Index, OR 2.23, 1.14-4.38; p=0.02), American Society of Anaesthesiologists' score (OR 2.56, 1.1-5.98; p=0.03), abdominal or back pain at presentation (OR 2.51, 1.05-5.9; p=0.038) and non metastatic liver disease as comorbidity (OR 4.5, 1.05-19.3; p=0.043). A score ranging from 0 to 7 points was developed. In the validation cohort, the model was able to predict early mortality (OR 7.1, 3.9-12.7; p<0.0001), with a predictive ability of 53.5% (Nagelkerke R2), an area under the receiver operating characteristic curve of 88.7% and an acceptable calibration (goodness-of-fit test, p=0.403). CONCLUSIONS: Our new simple risk score proved reliable in forecasting one year mortality in patients with resectable PDAC.
BACKGROUND: This study aimed to develop and validate a preoperative prognostic model for death within one year post-surgery in patients with resectable pancreatic ductal adenocarcinoma (PDAC). METHODS: A derivation cohort study of 296 patients who underwent surgical resection of PDAC was prospectively enrolled in an observational study. Preoperative predictors of one year mortality were used to develop a risk score which was then validated in an external cohort of 182 patients with resectable PDAC. RESULTS: Seventy-eight out of 296 patients (26%) died within the first year. Preoperative independent predictors of one year mortality were: nutritional status (Geriatric Nutritional Risk Index, OR 2.23, 1.14-4.38; p=0.02), American Society of Anaesthesiologists' score (OR 2.56, 1.1-5.98; p=0.03), abdominal or back pain at presentation (OR 2.51, 1.05-5.9; p=0.038) and non metastatic liver disease as comorbidity (OR 4.5, 1.05-19.3; p=0.043). A score ranging from 0 to 7 points was developed. In the validation cohort, the model was able to predict early mortality (OR 7.1, 3.9-12.7; p<0.0001), with a predictive ability of 53.5% (Nagelkerke R2), an area under the receiver operating characteristic curve of 88.7% and an acceptable calibration (goodness-of-fit test, p=0.403). CONCLUSIONS: Our new simple risk score proved reliable in forecasting one year mortality in patients with resectable PDAC.
Authors: Sven H Loosen; Frank Tacke; Niklas Püthe; Marcel Binneboesel; Georg Wiltberger; Patrick H Alizai; Jakob N Kather; Pia Paffenholz; Thomas Ritz; Alexander Koch; Frank Bergmann; Christian Trautwein; Thomas Longerich; Christoph Roderburg; Ulf P Neumann; Tom Luedde Journal: Carcinogenesis Date: 2019-08-22 Impact factor: 4.944