4.7 Article

A Pretreatment Prognostic Score to Stratify Survival in Pancreatic Cancer

Journal

ANNALS OF SURGERY
Volume 276, Issue 6, Pages E914-E922

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/SLA.0000000000004845

Keywords

CA19-9; neoadjuvant therapy; pancreatic cancer; pretreatment score; prognosis; survival

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This study developed and validated a prognostic score for pancreatic cancer based on pretreatment parameters. The score, called HELPP-score, was able to stratify survival independently of resection status and pathological tumor stage.
Objective:The aim of this study was to develop and validate a pretreatment prognostic score in pancreatic cancer (PDAC). Background:Pretreatment prognostication in PDAC is important for treatment decisions but remains challenging. Available prognostic tools are derived from selected cohorts of patients who underwent resection, excluding up to 20% of patients with exploration only, and do not adequately reflect the pretreatment scenario. Methods:Patients undergoing surgery for PDAC in Heidelberg from July 2006 to June 2014 were identified from a prospective database. Pretreatment parameters were extracted from the database and the laboratory information system. Parameters independently associated with overall survival by uni- and multivariable analyses were used to build a prognostic score. A contemporary cohort from Verona was used for external validation. Results:In 1197 patients, multiple pretreatment parameters were associated with overall survival by univariable analyses. American Society of Anesthesiology classification, carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen, C-reactive protein, albumin, and platelet count were independently associated with survival and were used to create the Heidelberg Prognostic Pancreatic Cancer (HELPP)-score. The HELPP-score was closely associated with overall survival (median survival between 31.3 and 4.8 months; 5-year survival rates between 35% and 0%) and was able to stratify survival in subgroups with or without resection as well as in CA19-9 nonsecretors. In the resected subgroup the HELPP-score stratified survival independently of pathological prognostic factors. The HELPP-score was externally validated and was superior to CA19-9 in both the development and validation cohorts. Conclusion:The HELPP-score is a readily available prognostic tool based on pretreatment routine parameters to stratify survival in PDAC independently of resection status and pathological tumor stage.

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