Clinical Study

Prognostic Factors and Prognostic Index for Chemonaïve and Gemcitabine-Refractory Patients with Advanced Pancreatic Cancer
R. Maréchal^a, A. Demols^a, F. Gay^a, V. De Maertelaere^c, M. Arvanitaki^a, A. Hendlisz^b, J.L. Van Laethem<sup>a

a</sup>Gastroenterology Department, Gastrointestinal Cancer Unit, Erasme Hospital University,
^bGastroenterology Department, Jules Bordet Institute and
^cDepartment of Biostatistics, Université Libre de Bruxelles, Brussels, Belgium

Address of Corresponding Author

Oncology 2007;73:41-51 (DOI: 10.1159/000120627)

  Key Words

• Pancreas
• Neoplasms
• Gemcitabine
• Prognosis

  Abstract

Background: Gemcitabine monotherapy is the cornerstone of the treatment of patients suffering from advanced pancreatic cancer (PC). For a few years, new chemotherapeutic agents and combinations have been under validation. The use of such treatment makes it necessary to determine factors that could predict survival time. Patients and Methods: To identify factors that predict survival time in chemonaïve patients with advanced PC and after gemcitabine failure, a retrospective analysis was performed on patients with advanced PC coming from phase II and III studies and treated with gemcitabine-based first-line chemotherapy. Results: Ninety-nine patients (median age 66 years, range 27-87) suffering from pathologically proven unresectable or metastatic adenocarcinoma of the pancreas were reviewed. Median overall survival time for the whole population was 251 days and progression-free survival in first- and second-line treatment was 108 and 67 days, respectively. The Cox regression analysis identified aspartate transaminase >53 IU/l, weight loss 10% and Karnofsky performance status <90 as significant independent negative prognostic factors in first-line and CA 19-9 >400 IU/ml and albumin 3.5 mg/dl in second-line chemotherapy. A prognostic index was calculated from the regression coefficients for each independent prognostic factor and used to classify the patients in 3 different groups with good, intermediate and poor prognosis. The prognosis index in chemonaïve and gemcitabine-refractory patients was (Karnofsy performance status × 0.52) + (weight loss × 1.10) + (aspartate transaminase × 0.82) and (albumin × 1.40) + (CA 19-9 × 0.74), respectively. Conclusions: Predictive factors could be identified in first- and second-line treatments, although they require prospective validation before they could be used in the design and analysis of future clinical trials.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

Maréchal Raphaël
Department of Gastroenterology, Gastrointestinal Cancer Unit, Erasme Hospital
808, route de Lennik
BE-1000 Bruxelles (Belgium)
Tel. +32 255 58 306, Fax +32 644 45 141, E-Mail raph_marechal@hotmail.com

  Article Information

Received: December 2, 2006
Accepted after revision: August 29, 2007
Published online: March 11, 2008
Number of Print Pages : 11
Number of Figures : 2, Number of Tables : 8, Number of References : 36