Early Mortality Risk Score: Identification of Poor Outcomes Following Upfront Surgery for Resectable Pancreatic Cancer
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Identifying pancreatic cancer patients at high risk of early mortality following pancreaticoduodenectomy (PD) is important for treatment decisions in a multidisciplinary setting. This study examines the preoperative predictors of early mortality following PD and combines these variables into an early mortality risk score (EMRS).
Medical records of patients who underwent PD for pancreatic adenocarcinoma at the Johns Hopkins Hospital between 30 August 1993 and 28 February 2005 were reviewed. Cox proportional hazards analysis was performed to identify predictors of early mortality, defined as death at 9 and 12 months. EMRS was constructed from univariate associated risk factors (age >75 years, tumor size ≥3cm, poor differentiation, co-morbid diseases) with each factor assigned 1 point (range of 0-4). EMRS was evaluated as an independent predictor of death at 9 and 12 months.
On univariate analysis, risk factors for death at 9 months included age ≥75 years (RR, 1.6; p = .009), comorbid disease (RR, 1.5; p = 0.020), tumor ≥3 cm (RR, 1.4; P = 0.050), and poor differentiation (RR, 2.1; P < 0.001). EMRS was associated with early mortality among those who did (p = 0.038) and did not receive adjuvant treatment (p < 0.001). A modified EMRS without tumor differentiation was also associated with early mortality (p < 0.001). Results persisted when reanalyzed using death at 12 months.
EMRS may identify patients at risk of early mortality following PD who may be candidates for alternatively sequenced treatment protocols. Prospective validation of this EMRS is needed.
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- Early Mortality Risk Score: Identification of Poor Outcomes Following Upfront Surgery for Resectable Pancreatic Cancer
Journal of Gastrointestinal Surgery
Volume 16, Issue 4 , pp 753-761
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Early mortality
- Risk score
- Pancreatic adenocarcinoma
- Industry Sectors
- Charles C. Hsu (1) (6)
- Christopher L. Wolfgang (2) (5)
- Daniel A. Laheru (3) (5)
- Timothy M. Pawlik (2) (5)
- Michael J. Swartz (1)
- Jordan M. Winter (2)
- Raymond Robinson (1)
- Barish H. Edil (2) (5)
- Amol K. Narang (1)
- Michael A. Choti (2)
- Ralph H. Hruban (4) (5)
- John L. Cameron (2) (5)
- Richard D. Schulick (2) (5)
- Joseph M. Herman (1) (5)
- Author Affiliations
- 1. The Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 410 North Broadway/Suite 1440, Baltimore, MD, 21231-2410, USA
- 6. The Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA
- 2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- 5. The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- 3. Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- 4. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA