Taxiarchis Botsis^1,2, Valsamo K. Anagnostou³, Gunnar Hartvigsen², George Hripcsak¹ and Chunhua Weng¹

¹Department of Biomedical Informatics, Columbia University, 10032 New York, USA. ²Department of Computer Science, University of Tromsø, 9037 Tromsø, Norway. ³Department of Pathology, Yale University School of Medicine, 06511 New Haven, USA.

Abstract

Background:  The accurate prognosis for patients with resectable pancreatic adenocarcinomas requires the incorporation of more factors than those included in AJCC TNM system.

Methods:  We identified 218 patients diagnosed with stage I and II pancreatic adenocarcinoma at NewYork-Presbyterian Hospital/ Columbia University Medical Center (1999 to 2009). Tumor and clinical characteristics were retrieved and associations with survival were assessed by univariate Cox analysis. A multivariable model was constructed and a prognostic score was calculated; the prognostic strength of our model was assessed with the concordance index.

Results: Our cohort had a median age of 67 years and consisted of 49% men; the median follow-up time was 14.3 months and the 5-year survival 3.6%. Age, tumor differentiation and size, alkaline phosphatase, albumin and CA 19-9 were the independent factors of the final multivariable model; patients were thus classified into low (n = 14, median survival = 53.7 months), intermediate (n = 124, median survival = 19.7 months) and high risk groups (n = 80, median survival = 12.3 months). The prognostic classification of our model remained significant after adjusting for adjuvant chemotherapy and the concordance index was 0.73 compared to 0.59 of the TNM system.

Conclusion:  Our prognostic model was accurate in stratifying patients by risk and could be incorporated into clinical decisions.