Predictors of Early Mortality in Veteran Patients With Pancreatic Cancer

Abstract

Introduction: For patients with pancreatic cancer, reliable predictors of outcome could be invaluable for directing management. The goal of this study was to identify factors that predict early mortality in these patients. Methods: We reviewed records of patients diagnosed with pancreatic cancer at our institution from 2005-2010. We divided them into early (≤6 months) and late (>6 months) mortality groups. We sought associations between mortality group and demographic/clinical factors by Fisher's Exact Test or Chisquare for categorical variables, and by two-sample t-test for continuous variables. Significant factors (p < 0.10) so identified were used in a multivariable analysis [MVA] regression model to identify independent predictors of early mortality. Results: We identified 109 patients with pancreatic cancer [100% men, 67% white, 29% black, 89% adenocarcinoma, 8% neuroendocrine (NET)]. Mean age and weight at diagnosis were 66±9.2 [SD] years and 81±17.6 kg, respectively. Tumor location: head (64%), body (10%), tail (19%), multiple locations (8%). Stage at presentation: I (2%), II (25%), III (14%), IV (60%). Treatments: surgery (24.7%), neoadjuvant (2.8%), palliative chemotherapy (37.6%). Kaplan-Meier analysis revealed overall median survival of 154 days (95%CI 93-194 days). Early (n=62) and late mortality groups (n=47) had similar mean age (p=0.2), weight (p=0.8), serum CA19-9 (p=0.2), and serum albumin levels (p=0.8). Factors associated with early mortality included tumors in the pancreatic body/tail (OR 7.54, p=0.06), black race (OR 1.48, p=0.03), larger tumor size (OR 1.4, p=0.01), abdominal pain (OR 5.85, p < 0.001), and advanced stage (OR 5.22, p=0.001). Conversely, factors associated with late mortality included NET (OR 0.13, p=0.066), and any treatment [surgery (p=0.005), neoadjuvant therapy (p=0.06), palliative chemotherapy (p < 0.001)]. On MVA (adjusting for stage), abdominal pain (OR=10.6, p=0.009) and larger tumor size (OR=2.4, p=0.03) were associated with early mortality, while palliative chemotherapy (OR=0.048, p=0.001) and NET (OR=0.009; p=0.02) were associated with late mortality. Conclusion: For our patients with pancreatic cancer, abdominal pain and larger tumor size were independently associated with early mortality, while palliative chemotherapy and NET were associated with improved survival. In contrast to some reports, we did not find that advanced age, elevated tumor markers, and low serum albumin were useful predictors of mortality.