Prognostic Factors for Advanced Pancreatic Cancer Treated with Gemcitabine Plus S-1: Retrospective Analysis and Development of a Prognostic Model

Abstract

Gemcitabine plus S-1 (GS) is commonly used to treat advanced pancreatic cancer (APC) in Asia. Few clinical experiments have demonstrated the clinical efficacy of GS in routine clinical practice. We aimed to identify the prognostic factors and develop a prognostic model for survival prediction in patients with APC, treated with GS. Records of 111 patients with newly diagnosed APC who received first-line palliative GS chemotherapy during 2010–2016 in Taiwan were analyzed retrospectively. Univariate and multivariate analyses were performed for the identification of prognostic factors. A prognostic model using prognosticators from the multivariate analysis was developed for survival prediction. The median overall survival (OS) for the cohort was 9.3 months (95% confidence interval [CI], 8.0–10.6). The prognostic model was constructed based on four independent prognosticators: performance status, tumor stage, pre-treatment albumin level, and neutrophil-to-lymphocyte ratio. Patients were categorized by tertiles into good, intermediate, and poor prognostic groups. The median OS values for each of these groups were 21.1 (95% CI, 8.2–33.9), 9.2 (95% CI, 8.3–10.1), and 5.8 months (95% CI, 4.4–7.1; log-rank p < 0.001), respectively. The bootstrapped corrected C-index of this model was 0.80 (95% CI, 0.71–0.89). The developed model was robust and could accurately predict survival in this population, and can assist clinicians and patients in survival discrimination and the determination of appropriate medical care goals. Additional research is needed to externally validate the model’s performance.

Validation and application of a prognostic model for patients with advanced pancreatic cancer receiving palliative chemotherapy

“…In line with the GS model, the current study helped identify performance status, tumor stage, albumin, and NLR as independent prognostic factors that predict survival outcome. Several prognostic models have been developed for survival prediction among APC patients receiving first‐line palliative chemotherapy .…”

“…[14][15][16][17][18][19][20][21][22][23][24][25] Only one of the models was designed prospectively 25 ; the others were retrospective studies. Of the 13 prognostic models, some were used for the prediction of survival outcome specifically for gemcitabine-based treatment, 11,14,16,19,22,24,25 while the other models consisted a broad spectrum of chemotherapeutic regimens. 15,17,18,20,21,23 The performance reflected by C-index ranged from 0.66 to 0.80 among these prognostic models.…”

“…[7][8][9][10] While palliative chemotherapy has shown prolonged survival, [4][5][6] there is an essential need to identify APC patients who might benefit the most and the least from such treatment since chemotherapy is often accompanied by extreme toxicity. [4][5][6][7][8][9][10] We previously developed a robust prognostic model (the GS model) 11 to predict survival outcomes of APC patients who received first-line palliative chemotherapy with gemcitabine plus S-1 (GS regimen). 12 Four independent variables-performance status, tumor stage, albumin, and neutrophil-to-lymphocyte ratio (NLR)-were selected to construct the model, which categorized patients into different prognostic groups for survival prediction.…”

Association of time interval between cancer diagnosis and initiation of palliative chemotherapy with overall survival in patients with unresectable pancreatic cancer

“…The patient's demographic data were recorded by the primary care physician using a prospectively formulated electronic data form and were described in detail elsewhere . Presence of tumor pain was defined as patient receiving narcotics for pain relief at the time of diagnosis.…”

“…The patient's demographic data were recorded by the primary care physician using a prospectively formulated electronic data form and were described in detail elsewhere. 12 Presence of tumor pain was defined as patient receiving narcotics for pain relief at the time of diagnosis. All jaundice in patients enrolled were the result of obstructive jaundice, which was defined as patients presented with biliary tract invasion and a total bilirubin level higher than 1.3 mg/dL at the time of diagnosis.…”