Abstract
ObjectiveTo assess the influence of biliary drainage to cholangitis on modified Glasgow Prognostic Score (mGPS) in patients with pancreatic cancer.MethodsmGPS was calculated before and after biliary drainage in 47 consecutive patients with inoperable pancreatic cancer who were receiving chemotherapy. Biliary drainage was indicated for malignant obstructive jaundice that prevented the administration of chemotherapy. To elucidate mGPS values, serum levels of CRP and albumin were measured at the time of diagnosis (before biliary drainage). Overall survival was evaluated and risk factors, which contribute to overall survival, were examined.ResultsBiliary drainage was performed in 15 patients. Using values obtained before biliary drainage, there were no significant differences in median survival time between patients with a mGPS of 0 and those with a mGPS of 1 or 2 (10.7 vs. 9.4 months; p = 0.757). However, using values obtained after biliary drainage, median survival time was significantly higher in patients with a mGPS of 0 than in those with a mGPS of 1 or 2 (11.4 vs. 4.7 months; p = 0.002). Multivariate analysis revealed that a mGPS of 1 or 2 (HR: 3.38; 95% CI: 1.35–8.46, p = 0.009), a carbohydrate antigen 19–9 >1000 U/mL (2.52; 1.22–5.23, p = 0.013), a performance status of 2 (7.68; 2.72–21.28, p = 0.001), carcinoembryonic antigen level >10 ng/mL (2.29; 1.13–4.61, p = 0.021) were independently associated with overall survival.ConclusionmGPS values obtained after biliary drainage appear to be a more reliable indicator of overall survival in patients with inoperable pancreatic cancer.
Highlights
It is widely recognized that cancer patient outcome is not solely dependent on tumor-related factors, but several patient-related factors play an important role
Using values obtained before biliary drainage, there were no significant differences in median survival time between patients with a modified Glasgow Prognostic Score (mGPS) of 0 and those with a mGPS of 1 or 2 (10.7 vs. 9.4 months; p = 0.757)
Using values obtained after biliary drainage, median survival time was significantly higher in patients with a mGPS of 0 than in those with a mGPS of 1 or 2 (11.4 vs. 4.7 months; p = 0.002)
Summary
It is widely recognized that cancer patient outcome is not solely dependent on tumor-related factors, but several patient-related factors play an important role. Few studies have evaluated the usefulness of the mGPS as a prognostic tool in patients with inoperable pancreatic cancer. Use of the mGPS is not internationally accepted, and its usefulness in patients with pancreatic cancer remains controversial. In some patients with pancreatic cancer, biliary obstruction leads to the development of cholangitis. In these patients, enhanced inflammatory responses may influence mGPS values. Studies that have examined the usefulness of mGPS values in inoperable pancreatic cancers have done so at the time of diagnosis, and before biliary drainage. The aim of the present study was to elucidate whether, in patients with inoperable pancreatic cancer, the prognostic value of mGPS values are altered following biliary drainage for cholangitis
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