Skip to main content
Top
Published in: International Journal of Clinical Oncology 5/2013

01-10-2013 | Original Article

Performance status of patients is the major prognostic factor at all stages of pancreatic cancer

Authors: Faruk Tas, Fatma Sen, Hatice Odabas, Leyla Kılıc, Serkan Keskın, Ibrahım Yıldız

Published in: International Journal of Clinical Oncology | Issue 5/2013

Login to get access

Abstract

Background

The aim of this study was to identify and evaluate the clinicopathologic factors and to elucidate the clinical importance of performance status on the outcome of patients with pancreatic cancer.

Materials and method

The data of 335 patients with histologically confirmed diagnosis of pancreatic cancer who were treated and followed up between 2000 and 2010 were recorded from medical charts.

Results

The median age of the patients was 59 years (range 25–88 years) and 226 (67.5 %) were male. The study group comprised localized disease (18 %), locally advanced disease (36 %) and metastatic disease (46 %). The median survival of all patients was 280 days and the 4-year survival rate was 5 %. Univariate analysis indicated that initial poor performance status of patients (PS 2–4) was significantly associated with shorter survival in localized (p = 0.015), locally advanced (p = 0.01), metastatic stage (p < 0.001) and in the whole group (p < 0.001). Multivariate analyses also showed the same findings except in local disease (p = 0.04 for locally advanced disease, p = 0.002 for metastatic stage, and p < 0.001 for all stages). In patients with poor performance status, severe weight loss (>10 %) (p = 0.007), large tumor diameter (>3 cm) (p = 0.046), and especially metastatic disease (p < 0.001) were associated with significantly shorter overall survival.

Conclusions

The performance status of a patient is the major prognostic factor predicting overall survival for all stages of pancreatic cancer. Severe weight loss, large tumor, and metastatic disease were found to be unfavorable prognostic factors in patients with poor performance status.
Literature
1.
go back to reference Sener SF, Fremgen A, Menck HR et al (1999) Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985–1995, using the National Cancer Database. J Am Coll Surg 189:1–7CrossRefPubMed Sener SF, Fremgen A, Menck HR et al (1999) Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985–1995, using the National Cancer Database. J Am Coll Surg 189:1–7CrossRefPubMed
2.
go back to reference Yeo CJ, Cameron JL, Sohn TA et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226:248–255CrossRefPubMed Yeo CJ, Cameron JL, Sohn TA et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226:248–255CrossRefPubMed
3.
go back to reference Sperti C, Pasquali C, Piccoli A et al (1996) Survival after resection for ductal adenocarcinoma of the pancreas. Br J Surg 83:625–631CrossRefPubMed Sperti C, Pasquali C, Piccoli A et al (1996) Survival after resection for ductal adenocarcinoma of the pancreas. Br J Surg 83:625–631CrossRefPubMed
4.
go back to reference Klaassen DJ, MacIntyre JM, Catton GE et al (1985) Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil—an Eastern Cooperative Oncology Group study. J Clin Oncol 3:373–378PubMed Klaassen DJ, MacIntyre JM, Catton GE et al (1985) Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil—an Eastern Cooperative Oncology Group study. J Clin Oncol 3:373–378PubMed
5.
go back to reference Chauffert B, Mornex F, Bonnetain F et al (2008) Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000–01 FFCD/SFRO study. Ann Oncol 19:1592–1599CrossRefPubMed Chauffert B, Mornex F, Bonnetain F et al (2008) Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000–01 FFCD/SFRO study. Ann Oncol 19:1592–1599CrossRefPubMed
6.
go back to reference Link KH, Gansauge F, Görich J et al (1997) Palliative and adjuvant regional chemotherapy in pancreatic cancer. Eur J Surg Oncol 23:409–414CrossRefPubMed Link KH, Gansauge F, Görich J et al (1997) Palliative and adjuvant regional chemotherapy in pancreatic cancer. Eur J Surg Oncol 23:409–414CrossRefPubMed
7.
go back to reference Papadoniou N, Kosmas C, Gennatas K et al (2008) Prognostic factors in patients with locally advanced (unresectable) or metastatic pancreatic adenocarcinoma: a retrospective analysis. Anticancer Res 28:543–549PubMed Papadoniou N, Kosmas C, Gennatas K et al (2008) Prognostic factors in patients with locally advanced (unresectable) or metastatic pancreatic adenocarcinoma: a retrospective analysis. Anticancer Res 28:543–549PubMed
8.
go back to reference Tas F, Aykan F, Alici S et al (2001) Prognostic factors in pancreatic carcinoma: serum LDH levels predict survival in metastatic disease. Am J Clin Oncol 24:547–550CrossRefPubMed Tas F, Aykan F, Alici S et al (2001) Prognostic factors in pancreatic carcinoma: serum LDH levels predict survival in metastatic disease. Am J Clin Oncol 24:547–550CrossRefPubMed
9.
go back to reference Krishnan S, Rana V, Janjan NA et al (2006) Prognostic factors in patients with unresectable locally advanced pancreatic adenocarcinoma treated with chemoradiation. Cancer 107:2589–2596CrossRefPubMed Krishnan S, Rana V, Janjan NA et al (2006) Prognostic factors in patients with unresectable locally advanced pancreatic adenocarcinoma treated with chemoradiation. Cancer 107:2589–2596CrossRefPubMed
10.
go back to reference Ozaki H, Hiraoka T, Mizumoto R et al (1999) The prognostic significance of lymph node metastasis and intrapancreatic perineural invasion in pancreatic cancer after curative resection. Surg Today 29:16–22CrossRefPubMed Ozaki H, Hiraoka T, Mizumoto R et al (1999) The prognostic significance of lymph node metastasis and intrapancreatic perineural invasion in pancreatic cancer after curative resection. Surg Today 29:16–22CrossRefPubMed
11.
go back to reference Micke O, Bruns F, Schäfer U et al (2003) CA 19-9 in the therapy monitoring and follow-up of locally advanced cancer of the exocrine pancreas treated with radiochemotherapy. Anticancer Res 23:835–840PubMed Micke O, Bruns F, Schäfer U et al (2003) CA 19-9 in the therapy monitoring and follow-up of locally advanced cancer of the exocrine pancreas treated with radiochemotherapy. Anticancer Res 23:835–840PubMed
12.
go back to reference Ziske C, Schlie C, Gorschlüter M et al (2003) Prognostic value of CA 19-9 levels in patients with inoperable adenocarcinoma of the pancreas treated with gemcitabine. Br J Cancer 89:1413–1417CrossRefPubMed Ziske C, Schlie C, Gorschlüter M et al (2003) Prognostic value of CA 19-9 levels in patients with inoperable adenocarcinoma of the pancreas treated with gemcitabine. Br J Cancer 89:1413–1417CrossRefPubMed
13.
go back to reference Hess V, Glimelius B, Grawe P et al (2008) CA 19-9 tumour-marker response to chemotherapy in patients with advanced pancreatic cancer enrolled in a randomised controlled trial. Lancet Oncol 9:132–138CrossRefPubMed Hess V, Glimelius B, Grawe P et al (2008) CA 19-9 tumour-marker response to chemotherapy in patients with advanced pancreatic cancer enrolled in a randomised controlled trial. Lancet Oncol 9:132–138CrossRefPubMed
14.
go back to reference Takeuchi M, Kondo S, Sugiura H et al (1998) Pre-operative predictors of short-term survival after pancreatic cancer resection. Hepatogastroenterology 45:2399–2403PubMed Takeuchi M, Kondo S, Sugiura H et al (1998) Pre-operative predictors of short-term survival after pancreatic cancer resection. Hepatogastroenterology 45:2399–2403PubMed
15.
go back to reference Cady B, Jenkins RL, Steele GD Jr et al (1998) Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome. Ann Surg 227:566–571CrossRefPubMed Cady B, Jenkins RL, Steele GD Jr et al (1998) Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome. Ann Surg 227:566–571CrossRefPubMed
16.
go back to reference Sobin LH, Wittekind Ch (eds) (1997) UICC TNM classification of malignant tumors, 5th edn. Wiley, New York Sobin LH, Wittekind Ch (eds) (1997) UICC TNM classification of malignant tumors, 5th edn. Wiley, New York
17.
go back to reference Schneider G, Siveke JT, Eckel F et al (2005) Pancreatic cancer: basic and clinical aspects. Gastroenterology 128:1606–1625CrossRefPubMed Schneider G, Siveke JT, Eckel F et al (2005) Pancreatic cancer: basic and clinical aspects. Gastroenterology 128:1606–1625CrossRefPubMed
18.
go back to reference Weber A, Kehl V, Mittermeyer T et al (2010) Prognostic factors for survival in patients with unresectable pancreatic cancer. Pancreas 39:1247–1253CrossRefPubMed Weber A, Kehl V, Mittermeyer T et al (2010) Prognostic factors for survival in patients with unresectable pancreatic cancer. Pancreas 39:1247–1253CrossRefPubMed
19.
go back to reference Ikeda M, Okada S, Tokuuye K et al (2001) Prognostic factors in patients with locally advanced pancreatic carcinoma receiving chemoradiotherapy. Cancer 91:490–495CrossRefPubMed Ikeda M, Okada S, Tokuuye K et al (2001) Prognostic factors in patients with locally advanced pancreatic carcinoma receiving chemoradiotherapy. Cancer 91:490–495CrossRefPubMed
20.
go back to reference Ishii H, Okada S, Nose H et al (1996) Prognostic factors in patients with advanced pancreatic cancer treated with systemic chemotherapy. Pancreas 12:267–271CrossRefPubMed Ishii H, Okada S, Nose H et al (1996) Prognostic factors in patients with advanced pancreatic cancer treated with systemic chemotherapy. Pancreas 12:267–271CrossRefPubMed
21.
go back to reference Engelken FJ, Bettschart V, Rahman MQ et al (2003) Prognostic factors in the palliation of pancreatic cancer. Eur J Surg Oncol 29:368–373CrossRefPubMed Engelken FJ, Bettschart V, Rahman MQ et al (2003) Prognostic factors in the palliation of pancreatic cancer. Eur J Surg Oncol 29:368–373CrossRefPubMed
22.
go back to reference Heinemann V, Quietzsch D, Gieseler F et al (2006) Randomized phase III trial of gemcitabine plus cisplatin compared with gemcitabine alone in advanced pancreatic cancer. J Clin Oncol 24:3946–3952CrossRefPubMed Heinemann V, Quietzsch D, Gieseler F et al (2006) Randomized phase III trial of gemcitabine plus cisplatin compared with gemcitabine alone in advanced pancreatic cancer. J Clin Oncol 24:3946–3952CrossRefPubMed
23.
go back to reference Louvet C, Labianca R, Hammel P et al (2005) Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol 23:3509–3516CrossRefPubMed Louvet C, Labianca R, Hammel P et al (2005) Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol 23:3509–3516CrossRefPubMed
24.
go back to reference Van Cutsem E, van de Velde H, Karasek P et al (2004) Phase III trial of gemcitabine plus tipifarnib compared with gemcitabine plus placebo in advanced pancreatic cancer. J Clin Oncol 22:1430–1438CrossRefPubMed Van Cutsem E, van de Velde H, Karasek P et al (2004) Phase III trial of gemcitabine plus tipifarnib compared with gemcitabine plus placebo in advanced pancreatic cancer. J Clin Oncol 22:1430–1438CrossRefPubMed
25.
go back to reference Storniolo AM, Enas NH, Brown CA et al (1999) An investigational new drug treatment program for patients with gemcitabine: results for over 3000 patients with pancreatic carcinoma. Cancer 85:1261–1268CrossRefPubMed Storniolo AM, Enas NH, Brown CA et al (1999) An investigational new drug treatment program for patients with gemcitabine: results for over 3000 patients with pancreatic carcinoma. Cancer 85:1261–1268CrossRefPubMed
26.
go back to reference Riess H, Helm A, Niedergethmann M et al (2005) A randomized, prospective, multicenter phase III trial of gemcitabine, 5-fluorouracil (5-FU), folinic acid vs gemcitabine alone in patients with advanced pancreatic cancer. Proc Am Soc Clin Oncol 23:4009 Riess H, Helm A, Niedergethmann M et al (2005) A randomized, prospective, multicenter phase III trial of gemcitabine, 5-fluorouracil (5-FU), folinic acid vs gemcitabine alone in patients with advanced pancreatic cancer. Proc Am Soc Clin Oncol 23:4009
Metadata
Title
Performance status of patients is the major prognostic factor at all stages of pancreatic cancer
Authors
Faruk Tas
Fatma Sen
Hatice Odabas
Leyla Kılıc
Serkan Keskın
Ibrahım Yıldız
Publication date
01-10-2013
Publisher
Springer Japan
Published in
International Journal of Clinical Oncology / Issue 5/2013
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI
https://doi.org/10.1007/s10147-012-0474-9

Other articles of this Issue 5/2013

International Journal of Clinical Oncology 5/2013 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine