Preoperative cognitive function predicts survival in patients with resectable pancreatic ductal adenocarcinoma

Abstract

Aims: Staging and prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) are defined by tumor stages according to the AJCC Cancer Staging Manual (TNM staging system). Multiple previous studies have demonstrated that clinicopathological factors such as tumor size, histologic differentiation, margin status, and nodal involvement are statistically significant prognostic variables for survival in patients undergoing resection for pancreatic cancer. The purpose of this study was to evaluate whether pre-surgery health-related quality of life (HRQoL) and subjectively rated symptom scores are independent prognostic factors for survival in patients with resectable PDAC. Methods: A prospective study of patients undergoing pancreatic resection for PDAC was conducted from November 2008 to December 2011. Patients completed the Edmonton Symptom Assessment System (ESAS) and the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-PAN26 questionnaires prior to surgery. Patient, tumor and treatment characteristics, and recurrence and survival were registered. Results: A total of 66 consecutive patients (male n=30/female n=36, median age 68 years) underwent R0/R1 resection for PDAC. Baseline ESAS and EORTC questionnaire compliance was 44/66 (66.7%). There were no statistically significant difference between compliers (n=44) and non-compliers (n=22) when comparing clinicopathological parameters and survival. The univariate analyses showed that three symptoms (nausea, dry mouth and cognitive function) and two clinicopathological factors (CA 19–9 >400 U/ml, lymph node ratio >0.1) were significantly associated with shorter survival. In the multivariate analysis, cognitive function was the only independent predictor for survival. Patients with low (<66.67%) and high (≥66.67%) cognitive function had a median survival of 11 and 21 months (p<0.001), respectively. Conclusions: In the present sample, presurgery cognitive function was a significant independent predictor of survival in patients with resectable PDAC. Thus, presurgery HRQoL scores may provide as strong prognostic information as clinicopathological factors in patients with resectable PDAC and should be routinely assessed.