Prognostic Factors in Patients with Pancreatic Adenocarcinoma and the Impact of Pancreatic Fistula on Oncologic Outcomes
Background Pancreatic cancer prognosis remains poor despite recent advances. We aimed to determine prognostic factors associated with pancreatic cancer outcome by retrospective analysis of patients who received curative surgical treatment. Methods In this retrospective study, we analyzed 226 pancreatic cancer patients who received curative surgical treatment from January 2004 to December 2015. The overall survival and disease-free survival rates were determined by the Kaplan- Meier method. Univariate analysis and multivariate analysis were conducted to identify potential and independent prognostic factors. Results The estimated 1, 2, 3, and 5-year overall survival rates after curative resections were 35.84%, 15.48%, and 6.19% respectively. The overall pancreatic fistula rate was 30.53%. Univariate and multivariate analyses identified the following independent prognostic factors for overall survival: microvascular invasion, neutrophil/lymphocyte ratio>5, modified Glasgow prognostic score and lymph node ratio>0.3. Additionally, microvascular invasion, neutrophil/lymphocyte ratio>5 and platelet/lymphocyte ratio>160 were independent prognostic factors for disease-free survival. Pancreatic fistula was not associated with worse overall survival or disease-free survival. Conclusion Although pancreatic fistula remains the major cause of morbidity after pancreatic resection, it did not appear to influence overall survival and disease-free survival. Inflammation markers, microvascular invasion and lymph node ratio should be thoroughly assessed as independent prognostic factors in pancreatic cancer.
Svoronos Christos, Tsoulfas Georgios, Chatzis I, Alatsakis Michael, Chatzitheoklitos Euthymmios