Performance Status Remained the Most Important Prognostic Factor in Pancreas Cancer Patients, Single Center Experience

Abstract

Introduction: Pancreas cancer is mostly diagnosed as locally advanced or metastatic stage. The prognosis of advanced pancreas cancer is still the worst gastrointestinal system cancer although new treatment and drug developments in the last decade. Methods: Between January 2007 and March 2012, a total of 193 patients diagnosed with pancreas cancer were retrospectively evaluated. We evaluated clinical, pathological and treatment characteristics of the patients and survival outcome. Modifications in dose intensity either by reduction of the planned dose or delay in treatment was noted. Statistical analysis was performed using SPSS Software version 15.0. Results: The patients' median age was 61 (range, 20-83) years. The numbers of male and female patients were 121 (62.7%) and 72 (37.3%), respectively. Primary tumor locations were head, body and tail and unknown in 115 (59.6%), 43 (22.3%), 25 (12.9%) and 10 (5.2%) respectively. Locally advanced and resectable, locally advanced unresectable and metastatic stages were seen in 26 (13.5%), 54 (28.0%) and 113 (58.5%) patients respectively. Liver was the primary metastatic site, diagnosed in 90 (46.6%) patients. Other metastatic sites were peritoneum, lung and combined. Adjuvant treatments were operation, chemoradiotherapy, and chemotherapy or combinations in total 26 (13.5%). Coronary artery disease was common comorbidity, occurring in 17 (8.8%) patients. First line chemotherapy (gemcitabine or gemcitabine plus platin) and second line chemotherapy (oxaliplatin based as FOLFOX or XELOX) were received by 69 (35.8%) and 24 (12.4%) of patients respectively. Partial response and stabile disease of first line chemotherapy were 22 (31.9%) and 17 (%24.6) respectively. Only short duration of stabile disease was achieved with second line therapy. The median overall survival (OS) and follow up time were 6.0 (CI: 4.6-7.4) months and 6.0 (0-75) months respectively. Only 8 patients were alive but others were all dead at the end of study. One year months survival rate was 30.0%. Median OS was differed in locally advanced-resectable, locally advanced-unresectable and metastatic stages respectively (17.0 months vs 9.0 months vs 4.0 months, p = 0.000). Overall survival was better in better ECOG performance status (ECOG 0-2) than worse ECOG performance status on diagnosis (13.3 months vs. 3.0 months, p = 0.000). Overall survival was also better in younger age groups than elderly (8.0 months vs. 6.0 months, p = 0.018). Sex, dose intensity, tumor localisations, adjuvant treatment, hypertension, diabetes or smoking status had no effect on OS. Chemotherapy had correlated with better OS in metastatic patients (7.0 months vs 1.0 months, p = 0.000) but this effect did not significant in locally advanced pancreas cancer patients (9.0 months vs 8.0 months, p = 0.393). Initial weight loss was also correlated with poor survival (4.0 months vs.9.0 months, p = 0.000). Multivariate analysis showed that only the ECOG performance status was an independent predictor of survival HR = 6,433, P = 0.000). Conclusion: Survival was rarely increased with any type of chemotherapy commonly used in pancreas cancer patients, performance status remained the most important prognostic factor. Prognostic effects of new treatment modalities such as folforinox or nab-paclitaxel combination treatments are also awaited.