Journal of Gastrointestinal Surgery

, Volume 16, Issue 4, pp 753–761 | Cite as

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

  • Charles C. Hsu
  • Christopher L. Wolfgang
  • Daniel A. Laheru
  • Timothy M. Pawlik
  • Michael J. Swartz
  • Jordan M. Winter
  • Raymond Robinson
  • Barish H. Edil
  • Amol K. Narang
  • Michael A. Choti
  • Ralph H. Hruban
  • John L. Cameron
  • Richard D. Schulick
  • Joseph M. Herman
Original Article

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 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • 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
  1. 1.The Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of Medical OncologyJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Department of PathologyJohns Hopkins University School of MedicineBaltimoreUSA
  5. 5.The Sol Goldman Pancreatic Cancer Research CenterJohns Hopkins University School of MedicineBaltimoreUSA
  6. 6.The Department of Radiation OncologyUniversity of California, San FranciscoSan FranciscoUSA

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