Original Article

Journal of Gastrointestinal Surgery

, Volume 16, Issue 4, pp 753-761

Early Mortality Risk Score: Identification of Poor Outcomes Following Upfront Surgery for Resectable Pancreatic Cancer

  • Charles C. HsuAffiliated withThe Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of MedicineThe Department of Radiation Oncology, University of California, San Francisco
  • , Christopher L. WolfgangAffiliated withDepartment of Surgery, Johns Hopkins University School of MedicineThe Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine
  • , Daniel A. LaheruAffiliated withDepartment of Medical Oncology, Johns Hopkins University School of MedicineThe Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine
  • , Timothy M. PawlikAffiliated withDepartment of Surgery, Johns Hopkins University School of MedicineThe Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine
  • , Michael J. SwartzAffiliated withThe Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine
  • , Jordan M. WinterAffiliated withDepartment of Surgery, Johns Hopkins University School of Medicine
  • , Raymond RobinsonAffiliated withThe Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine
  • , Barish H. EdilAffiliated withDepartment of Surgery, Johns Hopkins University School of MedicineThe Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine
  • , Amol K. NarangAffiliated withThe Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine
    • , Michael A. ChotiAffiliated withDepartment of Surgery, Johns Hopkins University School of Medicine
    • , Ralph H. HrubanAffiliated withDepartment of Pathology, Johns Hopkins University School of MedicineThe Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine
    • , John L. CameronAffiliated withDepartment of Surgery, Johns Hopkins University School of MedicineThe Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine
    • , Richard D. SchulickAffiliated withDepartment of Surgery, Johns Hopkins University School of MedicineThe Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine
    • , Joseph M. HermanAffiliated withThe Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of MedicineThe Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine Email author 

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Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.

Keywords

Early mortality Risk score Resectable Pancreatic adenocarcinoma