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Updates in Surgery
Published in: Updates in Surgery 1/2021

Open Access 01-02-2021 | Pancreatectomy | Original Article

Factors predicting survival in patients with locally advanced pancreatic cancer undergoing pancreatectomy with arterial resection

Authors: Niccolò Napoli, Emanuele Kauffmann, Concetta Cacace, Francesca Menonna, Davide Caramella, Carla Cappelli, Daniela Campani, Andrea Cacciato Insilla, Enrico Vasile, Caterina Vivaldi, Lorenzo Fornaro, Gabriella Amorese, Fabio Vistoli, Ugo Boggi

Published in: Updates in Surgery | Issue 1/2021

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Abstract

Pancreatectomy with arterial resection is a treatment option in selected patients with locally advanced pancreatic cancer. This study aimed to identify factors predicting cancer-specific survival in this patient population. A single-Institution prospective database was used. Pre-operative prognostic factors were identified and used to develop a prognostic score. Matching with pathologic parameters was used for internal validation. In a patient population with a median Ca 19.9 level of 19.8 U/mL(IQR: 7.1–77), cancer-specific survival was predicted by: metabolic deterioration of diabetes (OR = 0.22, p = 0.0012), platelet count (OR = 1.00; p = 0.0013), serum level of Ca 15.3 (OR = 1.01, p = 0.0018) and Ca 125 (OR = 1.02, p = 0.00000137), neutrophils-to-lymphocytes ratio (OR = 1.16; p = 0.00015), lymphocytes-to-monocytes ratio (OR = 0.88; p = 0.00233), platelets-to-lymphocytes ratio (OR = 0.99; p = 0.00118), and FOLFIRINOX neoadjuvant chemotherapy (OR = 0.57; p = 0.00144). A prognostic score was developed and three risk groups were identified. Harrell’s C-Index was 0.74. Median cancer-specific survival was 16.0 months (IQR: 12.3–28.2) for the high-risk group, 24.7 months (IQR: 17.6–33.4) for the intermediate-risk group, and 39.0 months (IQR: 22.7–NA) for the low-risk group (p = 0.0003). Matching the three risk groups against pathology parameters, N2 rate was 61.9, 42.1, and 23.8% (p = 0.04), median value of lymph-node ratio was 0.07 (IQR: 0.05–0.14), 0.04 (IQR:0.02–0.07), and 0.03 (IQR: 0.01–0.04) (p = 0.008), and mean value of logarithm odds of positive nodes was − 1.07 ± 0.5, − 1.3 ± 0.4, and − 1.4 ± 0.4 (p = 0.03), in the high-risk, intermediate-risk, and low-risk groups, respectively. An online calculator is available at www.​survivalcalculat​or-lapdac-arterialresectio​n.​org. The prognostic factors identified in this study predict cancer-specific survival in patients with locally advanced pancreatic cancer and low Ca 19.9 levels undergoing pancreatectomy with arterial resection.
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Metadata
Title
Factors predicting survival in patients with locally advanced pancreatic cancer undergoing pancreatectomy with arterial resection
Authors
Niccolò Napoli
Emanuele Kauffmann
Concetta Cacace
Francesca Menonna
Davide Caramella
Carla Cappelli
Daniela Campani
Andrea Cacciato Insilla
Enrico Vasile
Caterina Vivaldi
Lorenzo Fornaro
Gabriella Amorese
Fabio Vistoli
Ugo Boggi
Publication date
01-02-2021
Publisher
Springer International Publishing
Published in
Updates in Surgery / Issue 1/2021
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-020-00883-7

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