A New Score to Predict the Resectability of Pancreatic Adenocarcinoma: The BACAP Score
Abstract
:1. Introduction
2. Results
2.1. Patients
2.2. Baseline Characteristics
2.3. Clinico-Radiological Variables That Predict the Resectability Status
2.4. The Predictive Score (the BACAP Score)
2.5. Overall Survival
3. Discussion
4. Materials and Methods
4.1. Population
4.2. Main Objective
4.3. Data Collected
4.4. Statistical Methods
4.5. Ethics Statement and Consent to Participate
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
ALT | alanine aminotransferase |
AST | aspartate aminotransferase |
BACAP | National Anatomo-Clinical Database on Pancreatic Adenocarcinoma |
CA19-9 | Carbohydrate antigen 19-9 |
CEA | Carcinoembryonic antigen |
CT-scan | Computed tomography scan |
EUS | Endoscopic ultrasound |
ERCP | Endoscopic retrograde cholangiopancreatography |
INR | International Normalized Ratio |
IPMN | Intraductal papillary mucinous neoplasm |
LA | Locally advanced |
Met | Metastatic |
MRI | Magnetic resonance imaging |
MTM | Multidisciplinary Team Meeting |
PDAC | Pancreatic ductal adenocarcinoma |
PET/CT | Positron emission tomography/computed tomography |
PS | Performance status |
Res | Resectable |
ROC curve: | Receiver operating characteristic curve |
TNM | Tumor node metastasis |
WHO | World Health Organization |
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PDAC Patient Characteristics at Baseline (Univariate Analysis) | Res (n = 164) | LA (n = 266) | Met (n = 273) | Total (n = 703) | p |
---|---|---|---|---|---|
Demographic Data | |||||
Age on diagnosis (median, range) (MD) | 69 (21–88) (0) | 71 (34–91) (0) | 69 (36–91) (0) | 70 (21–91) (0) | 0.070 |
Gender (n, %) (MD) | 0.408 | ||||
Female | 73 (44.5) (0) | 129 (48.5) (0) | 117 (42.9) (0) | 319 (45.4) (0) | |
Male | 91 (55.5) (0) | 137 (51.5) (0) | 156 (57.1) (0) | 384 (54.6) (0) | |
Body mass index on diagnosis (median, range) (MD) | 24.4 (15–52) (3) | 23.5 (15.6–114.3) (5) | 24.1 (14.2–112) (13) | 23.9 (14.2–114.3) (21) | 0.05 |
Medical History | |||||
WHO performance status (n, %) (MD) | < 0.001 | ||||
0 | 76 (58.9) (35) | 86 (36.3) (29) | 88 (37.1) (36) | 250 (41.5) (100) | |
1 | 48 (37.2) (35) | 124 (52.3) (29) | 101 (42.6) (36) | 273 (45.3) (100) | |
≥2 | 5 (3.9) (35) | 27 (11.4) (29) | 48 (20.3) (36) | 80 (13.3) (100) | |
Smoking history (n, %) (MD) | 0.097 | ||||
Non-smoker | 76 (46.3) (0) | 145 (54.9) (2) | 131 (49.1) (6) | 352 (50.7) (8) | |
Former smoker | 46 (28.1) (0) | 75 (28.4) (2) | 89 (33.3) (6) | 210 (30.2) (8) | |
Current smoker | 42 (25.6) (0) | 44 (16.7) (2) | 47 (17.6) (6) | 133 (19.1) (8) | |
Alcohol consumption (n, %) (MD) | 0.791 | ||||
Non-consumer | 100 (61.4) (1) | 174 (66.4) (4) | 179 (66.5) (4) | 453 (65.3) (9) | |
Former consumer | 17 (10.4) (1) | 21 (8.0) (4) | 24 (8.9) (4) | 62 (8.9) (9) | |
Current consumer | 46 (28.2) (1) | 67 (25.6) (4) | 66 (24.5) (4) | 179 (25.8) (9) | |
Family history of cancer (n, %) (MD) | 66 (40.2) (0) | 123 (46.2) (0) | 128 (47.1) (1) | 317 (45.2) (1) | 0.346 |
Diabetes (n, %) (MD) | 44 (26.8) (0) | 74 (27.8) (0) | 61 (22.4) (1) | 179 (25.5) (1) | 0.323 |
Other pancreatic diseases * (n, %) (MD) | 30 (18.3) (0) | 20 (7.5) (0) | 15 (5.5) (0) | 65 (9.3) (0) | < 0.001 |
Clinical condition on diagnosis | |||||
Venous or arterial thrombosis (n, %) (MD) | 7 (4.3) (0) | 39 (14.7) (0) | 51 (18.7) (0) | 97 (13.8) (0) | < 0.001 |
Weight loss (n, %) (MD) | 90 (55.6) (2) | 200 (76.1) (3) | 186 (68.6) (2) | 476 (68.4) (7) | < 0.001 |
Abdominal pain (n, %) (MD) | 89 (54.3) (0) | 193 (72.8) (1) | 201 (73.9) (1) | 483 (69) (2) | < 0.001 |
Jaundice (n, %) (MD) | 80 (48.8) (0) | 116 (43.8) (1) | 68 (25) (1) | 264 (37.7) (2) | < 0.001 |
Acute pancreatitis (n, %) (MD) | 19 (11.6) (0) | 11 (4.2) (2) | 8 (2.9) (1) | 38 (5.4) (3) | < 0.001 |
Tumor Characteristics and Procedures | |||||
Maximal tumor size (mm) (median, range) (MD) | 27 (7–76) (15) | 35 (4–85) (10) | 36 (2–150) (12) | 33 (2–150) (37) | < 0.001 |
Tumor location: head of pancreas (n, %) (MD) | 117 (72.2) (2) | 169 (63.8) (1) | 125 (47) (7) | 411 (59.3) (10) | < 0.001 |
Biliary drainage (%) (MD) | 60 (36.6) (0) | 112 (42.1) (0) | 69 (25.3) (0) | 241 (34.3) (0) | < 0.001 |
Surgical resection by pancreaticoduodenectomy (n, %) (MD) | 58 (79.4) (0) | 0 (0) | 0 (0) | 58 (8.3) (0) | - |
Biology on Diagnosis | |||||
Serum bilirubin (μmol/L) (median, range) (MD) | 32.5 (2.5–533.3) (34) | 32 (3.4–647) (83) | 12.8 (3.4–548) (78) | 18.4 (2.5–647) (195) | 0.004 |
CA 19-9 (IU/mL) (median, range) (MD) | 183.5 (0.1–5314) (84) | 247.6 (0–240000) (152) | 521.7 (0–135720) (129) | 261.2 (0–240000) (365) | < 0.001 |
CEA (IU/ml) (median, range) (MD) | 3 (0.6–44.4) (99) | 5 (0.5–3862) (177) | 11 (0.7–11394) (147) | 5.3 (0.5–11394) (423) | < 0.001 |
Predictive Clinico-Radiological Factors of Resectability (Multivariate Analysis) | OR | 95% CI | p |
---|---|---|---|
Venous or arterial thrombosis on diagnosis | |||
No | |||
Yes | 0.30 | 0.11; 0.81 | 0.017 |
WHO Performance Status on diagnosis | |||
0 | |||
1 | 0.58 | 0.35; 0.95 | 0.032 |
≥ 2 | 0.25 | 0.09; 0.72 | 0.010 |
Weight loss on diagnosis | |||
≤8% | |||
≥ 8% | 0.55 | 0.34; 0.91 | 0.019 |
Abdominal pain on diagnosis | |||
No | |||
Yes | 0.46 | 0.28; 0.76 | 0.003 |
Location of the tumor | |||
Head | |||
Body and tail | 0.42 | 0.24; 0.75 | 0.005 |
Maximal tumor size (mm) | |||
≤20 | |||
20–33 | 0.49 | 0.28; 0.86 | 0.013 |
> 33 | 0.11 | 0.05; 0.20 | <0.001 |
The BACAP Score | 𝑥n | 𝛽i |
---|---|---|
Venous or arterial thrombosis on diagnosis: | ||
No | 0 | |
Yes | 1 | −1.21 |
WHO Performance Status on diagnosis: | ||
0 | 0 | |
1 | 1 | −0.55 |
≥2 | 2 | −1.37 |
Weight loss on diagnosis: | ||
<8% on diagnosis | 0 | |
≥8% on diagnosis | 1 | −0.59 |
Abdominal pain on diagnosis: | ||
No | 0 | |
Yes | 1 | −0.77 |
Location of the tumor: | ||
Head | 0 | |
Body and tail | 1 | −0.86 |
Maximal tumor size: | ||
≤20 mm | 0 | |
20–33 mm | 1 | −0.70 |
>33 mm | 2 | −2.25 |
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Share and Cite
Maulat, C.; Canivet, C.; Touraine, C.; Gourgou, S.; Napoleon, B.; Palazzo, L.; Flori, N.; Piessen, G.; Guibert, P.; Truant, S.; et al. A New Score to Predict the Resectability of Pancreatic Adenocarcinoma: The BACAP Score. Cancers 2020, 12, 783. https://doi.org/10.3390/cancers12040783
Maulat C, Canivet C, Touraine C, Gourgou S, Napoleon B, Palazzo L, Flori N, Piessen G, Guibert P, Truant S, et al. A New Score to Predict the Resectability of Pancreatic Adenocarcinoma: The BACAP Score. Cancers. 2020; 12(4):783. https://doi.org/10.3390/cancers12040783
Chicago/Turabian StyleMaulat, Charlotte, Cindy Canivet, Célia Touraine, Sophie Gourgou, Bertrand Napoleon, Laurent Palazzo, Nicolas Flori, Guillaume Piessen, Pierre Guibert, Stéphanie Truant, and et al. 2020. "A New Score to Predict the Resectability of Pancreatic Adenocarcinoma: The BACAP Score" Cancers 12, no. 4: 783. https://doi.org/10.3390/cancers12040783