Survival rate

Cohort

Surgery

Proportional hazards model

Multivariate analysis

Pancreatic cancer

Comorbidity

Internal medicine

Survival analysis

Confidence interval

Hazard ratio

Oncology

Medicine

Disease

Cancer

Background: Evaluation of a clinical classification system for PDAC introduced by the MDACC. (Type A: resectable/borderline tumor anatomy, Type B: resectable/borderline resectable tumor anatomy with clinical findings suspicious for extrapancreatic disease, Type C: marginal performance status/severe pre-existing comorbidity profile, age>80). Methods: Evaluated based on a multicenter database of patients undergoing surgery from 2005 to 2016 due to PDAC (n=1157).Complications were classified using the Clavien-Dindo classification. Chi-square test, Kaplan–Meier estimator and Cox regression hazard model were used for statistical analysis. Results: Most patients (55.1%) were classified as type A, followed by type C (35.4%) and type B patients (9.4%) respectively. Regarding postoperative morbidity, 20.1% of all patients developed a relevant surgical complication (Grade III-V), 90 days' mortality rate was 3.8%. Type B patients had a significant worse disease free survival (10.5 month, p<0.001) and overall survival (24 month, p=0.001), while no difference was evident between type A and C patients. Multivariate analysis identified the type B classification as a negative prognostic marker for disease free survival (p=0.001, HR 1.53). Conclusion: Type C patients did not show a higher morbidity and mortality rate. No difference in survival was seen. The prognosis seems to be related to the presence of findings suspicious for extrapancreatic disease, not to a marginal performance status or a severe pre-existing comorbidity profile.

External validation of the MDACC clinical classification system for pancreatic cancer in a European multicenter cohort