Factors predicting survival in patients with locally advanced pancreatic cancer undergoing pancreatectomy with arterial
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ORIGINAL ARTICLE
Factors predicting survival in patients with locally advanced pancreatic cancer undergoing pancreatectomy with arterial resection Niccolò Napoli5 · Emanuele Kauffmann5 · Concetta Cacace5 · Francesca Menonna5 · Davide Caramella1 · Carla Cappelli1 · Daniela Campani2 · Andrea Cacciato Insilla2 · Enrico Vasile3 · Caterina Vivaldi3 · Lorenzo Fornaro3 · Gabriella Amorese4 · Fabio Vistoli5 · Ugo Boggi5 Received: 3 June 2020 / Accepted: 3 September 2020 © The Author(s) 2020
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), plateletsto-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.survivalcalculator-lapdac-arterialresection.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. Keywords Locally advanced pancreatic cancer · Pancreatic cancer · Pancreatectomy · Arterial resection · Vascular resection · Prognostic score
* Ugo Boggi [email protected] 1
Division of Radiology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
2
Division of Pathology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
3
Division of Oncology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
4
Division of Anesthesia and Intensive Care,
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