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 NANNO1
- Publication Type:journal article
- From:Innovation
2014;8(4):112-113
- CountryMongolia
- Language:English
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Abstract:
Background: Pancreatic Ductal Adenocarcinoma (PDAC) is one of the mostcommon malignant tumors both in Japan and Mongolia. Surgical resection isconsidered to be the potentially curative treatment for PDAC without distantmetastases. Nevertheless, the 5-year overall survival rate after pancreaticresection alone has been reported only 8 to 10 %. The most significant factoraffecting survival is the high rate of postoperative recurrence. The introductionof chemotherapy in adjuvant settings has been proved beneficial and prolongedoverall survival rate. However, some patients are failed to complete adjuvantchemotherapy and obtain significantly less survival benefit. In this study, weretrospectively reviewed the impact of completion of adjuvant chemotherapyon survival and revealed independent risk factors of incompletion of adjuvantchemotherapy.Methods: From January 2000 and September 2012, a total of 236 consecutivepatients at Kobe University Hospital who were planned pancreatic resection forPDAC. Forty-five patients who had metastatic disease (liver, peritoneum and/ordistant lymph nodes) at laparotomy, 13 patients with R2 resection, and 46 patientswho did not receive adjuvant chemotherapy were excluded, and the remaining132 patients received adjuvant chemotherapy (gemcitabine alone, S1 alone, orgemcitabine plus S1 regimen) for 6 months. Excluding 27 patients discontinuedtherapy 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 serumalbumin level), intraoperative factors (type of operative procedure, duration ofoperation, 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) wereevaluated.Results: Seventy-five (71 %) patients completed adjuvant chemotherapy(complete group), and 30 (29 %) patients discontinued therapy due to adverseevents (incomplete group). Patient survival was significantly better in completegroup than in incomplete group (median survival time; 48.9 months vs 17.9months, 5-year survival rate; 42.7 % vs 17.1 %). The statistically significantfactors in incomplete adjuvant chemotherapy by univariate analysis were highpreoperative WBC, type of pancreatectomy (pancreatoduodenectomy or totalpancreatectomy vs distal pancreatectomy), postoperative body weight loss ≥ 7.5%, and low postoperative serum albumin level). Among these factors, multivariateanalyses identified that low postoperative serum albumin level was identified assignificant predictors for failure to complete adjuvant chemotherapy (odds ratio0.02, 95 % confidence interval 0.002 to 0.14; P < 0.001). The cutoff value ofthe postoperative serum albumin level was determined using receiver operatingcharacteristic curve, the area under the curve was 0.79, and the cutoff value was3.1 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 albuminlevel 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 highergroup respectively (p < 0.001).Conclusions: Patients who completed adjuvant chemotherapy had significantlybetter survival rate than those who failed to complete adjuvant chemotherapy.Postoperative serum albumin level was identified as an independent risk factorof incomplete adjuvant chemotherapy. Postoperative serum albumin level ≥ 3.1mg/dl is a good marker of predicting completion of adjuvant chemotherapy andbetter survival. Maintenance of postoperative nutritional condition may be one ofthe important factors to achieve best prognosis in the treatment of PDAC.
