Postoperative Serum Albumin Level is an Independent Risk Factor of Incomplete Adjuvant Chemotherapy in Patients with Pancreatic Ductal Carcinoma
- VernacularTitle:Хагалгааны дараах сийвэн дахь альбумины төвшиннь нойр булчирхайн сувгийн өмөнтэй өвчтөнүүдэд адьювант хими эмчилгээ бүрэн бус болох чухал эрсдэлт хүчин зүйл болох нь
- Author:
YOSHIHIDE NANNO
- Publication Type:journal article
- From:Innovation
2014;8(4):112-113
- CountryMongolia
- Language:English
-
Abstract:
Background: Pancreatic Ductal Adenocarcinoma (PDAC) is one of the most
common malignant tumors both in Japan and Mongolia. Surgical resection is
considered to be the potentially curative treatment for PDAC without distant
metastases. Nevertheless, the 5-year overall survival rate after pancreatic
resection alone has been reported only 8 to 10 %. The most significant factor
affecting survival is the high rate of postoperative recurrence. The introduction
of chemotherapy in adjuvant settings has been proved beneficial and prolonged
overall survival rate. However, some patients are failed to complete adjuvant
chemotherapy and obtain significantly less survival benefit. In this study, we
retrospectively reviewed the impact of completion of adjuvant chemotherapy
on survival and revealed independent risk factors of incompletion of adjuvant
chemotherapy.
Methods: From January 2000 and September 2012, a total of 236 consecutive
patients at Kobe University Hospital who were planned pancreatic resection for
PDAC. Forty-five patients who had metastatic disease (liver, peritoneum and/or
distant lymph nodes) at laparotomy, 13 patients with R2 resection, and 46 patients
who did not receive adjuvant chemotherapy were excluded, and the remaining
132 patients received adjuvant chemotherapy (gemcitabine alone, S1 alone, or
gemcitabine plus S1 regimen) for 6 months. Excluding 27 patients discontinued
therapy due to recurrent disease during adjuvant chemotherapy, 105 patients
(55 men and 50 women) were enrolled in this analysis. Preoperative factors
(sex, age, body mass index [BMI], comorbidity, carcinoembrionic antigen [CEA]
level, carbohydrate antigen 19-9 [CA19-9] level, white blood cell count [WBC],
lymphocyte count, C-reactive protein [CRP] level, total protein level, and serum
albumin level), intraoperative factors (type of operative procedure, duration of
operation, and intraoperative blood transfusion), postoperative factors (tumor size,
stages, histological type, lymph node metastasis, postoperative complications,
body weight loss, CEA level, CA19-9 level, WBC, lymphocyte count, CRP level,
total protein level, serum albumin level, and serum cholinesterase level) were
evaluated.
Results: Seventy-five (71 %) patients completed adjuvant chemotherapy
(complete group), and 30 (29 %) patients discontinued therapy due to adverse
events (incomplete group). Patient survival was significantly better in complete
group than in incomplete group (median survival time; 48.9 months vs 17.9
months, 5-year survival rate; 42.7 % vs 17.1 %). The statistically significant
factors in incomplete adjuvant chemotherapy by univariate analysis were high
preoperative WBC, type of pancreatectomy (pancreatoduodenectomy or total
pancreatectomy vs distal pancreatectomy), postoperative body weight loss ≥ 7.5
%, and low postoperative serum albumin level). Among these factors, multivariate
analyses identified that low postoperative serum albumin level was identified as
significant predictors for failure to complete adjuvant chemotherapy (odds ratio
0.02, 95 % confidence interval 0.002 to 0.14; P < 0.001). The cutoff value of
the postoperative serum albumin level was determined using receiver operating
characteristic curve, the area under the curve was 0.79, and the cutoff value was
3.1 mg/dl. The adjuvant chemotherapy was completed in 85.5 % and 44.4 % (p <
0.001) in lower (< 3.1 mg/dl) and high (≥ 3.1 mg/dl) postoperative serum albumin
level groups, respectively. The overall 1-, 3-, 5-year survival rates were 73.9 %,
22.4 %, 18.0 % in a lower group, and 96.8 %, 64.6 %, and 41.0 % in a higher
group respectively (p < 0.001).
Conclusions: Patients who completed adjuvant chemotherapy had significantly
better survival rate than those who failed to complete adjuvant chemotherapy.
Postoperative serum albumin level was identified as an independent risk factor
of incomplete adjuvant chemotherapy. Postoperative serum albumin level ≥ 3.1
mg/dl is a good marker of predicting completion of adjuvant chemotherapy and
better survival. Maintenance of postoperative nutritional condition may be one of
the important factors to achieve best prognosis in the treatment of PDAC.
