Survival Analysis of Veteran Patients with Pancreatic Cancer

Abstract

Background

For patients with pancreatic cancer, the identification of reliable predictors of outcome could be invaluable for directing management.

Aims

The goal of this study was to identify clinical and laboratory factors that predict early versus late mortality.

Methods

Medical records of patients diagnosed with pancreatic cancer in the Dallas VA from 2005 to 2010 were retrospectively reviewed and divided into two groups, early (≤6 months) and late (>6 months) mortality groups. Univariable (UVA) and multivariable analyses (MVA) were performed and the utility of CA 19-9 was explored.

Results

109 patients with pancreatic cancer (89% adenocarcinoma) were divided into early (n = 62) and late (n = 47) mortality groups. Kaplan-Meier analysis revealed median survival of 154 days (95%CI 93-194 days). On MVA, abdominal pain (OR = 10.6, p = 0.009) and larger tumor size (OR = 2.4, p = 0.028) were significantly associated with early mortality, while palliative chemotherapy (OR = 0.048, p = 0.001) and neuroendocrine tumor (OR = 0.009; p = 0.024) were significantly associated with late mortality. Subgroup analysis of adenocarcinoma and late stage patients revealed similar results. Serum CA 19-9 performed poorly as a prognostic indicator in early vs. late mortality groups (p = 0.43), in metastatic disease at diagnosis (p = 0.32) and after treatment (p = 0.65).

Conclusions

Abdominal pain and large tumor size portends poor prognosis in patients with pancreatic cancer. Palliative chemotherapy and surgical intervention may prolong survival. CA 19-9 is not universally reliable for predicting metastasis, survival, or response to chemotherapy.

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