Prognostic factors related with survival in patients with pancreatic adenocarcinoma

Table 1 Surgical and pathological factors in pancreatic cancer

Ref.	No. of patients	Results
Surgical margin/resection (R1 vs R0)
Menon et al[12]	27	mOS, 14 mo vs NR
Raut et al[13]	360	mOS, 21.5 mo vs 27.8 mo
Lymph nodes status and lymph node ratio
Riediger et al[17]	204	LNR was an independent prognostic factor
Valsangkar et al[18]	14907	LNR was strongly correlated with survival
Perineural and blood vessel invasion
Chatterjee et al[21]	86	mOS, 34 mo for BVI (-) vs 22 mo for BVI (+);
		mOS, 32 mo for PNI (-) vs 22 mo for PNI (+)
Tumor localization
Park et al[8]	340	It was an important prognostic factor by univariate analysis
Zhang et al[7]	302	It was an independent prognostic indicator
Operative factors
Nagai et al[23]	271	OBL greater than 2000 mL was an independent prognostic factor for OS
Keck et al[24]	270	PBT was an independent prognostic indicator for survival

mOS: Median overall survival; NR: Not reach; LNR: Lymph node ratio; BVI: Blood vessel invasion; PNI: Perineural invasion; OBL: Operative blood loss; PBT; Perioperative blood transfusion.

Table 2 Clinical prognostic factors in pancreatic cancer in selected trials

Ref.	No. of patients	Results
Performance status
Sezgin et al[25]	67	PS was an independent prognostic factor for OS
Tas et al[26]	335	Initial poor PS (2-4) was significantly associated with worse survival
DM, obesity and jaundice
Gong et al[31]	510	HR = 1.3 for patients with BMI ≥ 30 compare to those with BMI < 25. But no correlation was found between BMI and survival
Yuan et al[33]	902	Higher baseline BMI was associated with reduced survival
Smith et al[34]	155	The presence of jaundice at the time of surgery was a significant adverse predictor of early survival
Strasberg et al[36]	400	The preoperative jaundice was found to be a significant indicator of poor outcome
Treatment
Park et al[8]	340	mOS, 11.3 vs 10.4 vs 6.4 mo for stage III patients treated with CT, CCRT and BSC, respectively (P < 0.001)
		mOS, 6.4 vs 3.1 mo for patients with stage IV treated with CT or BSC, respectively (P < 0.001)
Lee et al[19]	82	Gemcitabine chemotherapy was found to be the only independent prognostic indicator for OS in advanced pancreatic cancer

DM: Diabetes mellitus; mOS: Median overall survival; PS:Performance status, BMI: Body mass index; CT: Chemotherapy; CCRT: Concurrent chemoradiotherapy; BSC: Best supportive care.

Table 3 Selected trials of laboratory prognostic factors in pancreatic cancer

Ref.	No. of patients	Results
CA 19-9 levels
Park et al[8]	340	Elevated CA19-9 levels (> 670 U/mL) were found to independent prognostic factor for OS
Zhang et al[7]	302	mOS, 3.8 mo for patients with high CA 19-9 levels vs 5.0 mo for those with normal CA 19-9 levels
Humphris et al[47]	260	mOS, 25.6 mo for low postoperative CA 19-9 levels vs 14.8 mo for high CA 19-9 levels
		Normalization of CA19-9 within 6 mo of resection was also an independent favorable prognostic factor
Other tumor markers
Zhang et al[7]	302	mOS, 2.0 mo for patients with high CEA levels vs 5.0 mo for those with normal CEA levels
Lee et al[22]	187	mOS was 16.3 and 10.2 mo for patients with normal CEA vs high CEA levels, repsectively
Hematological factors
Zhang et al[7]	302	WBCs were independent prognostic factor for OS
Smith et al[58]	110	mOS in patients with a preoperative PLR of 150 or less was 19.7 mo, 13.7 mo in those with a PLR of 151-300, and 5.8 mo in patients with a value of > 300
Aliustaoglu et al[57]	65	Patients with a NLR value of < 5 had a significantly higher median OS time compared to those with a NLR value of ≥ 5
Stotz et al[56]	371	An increased NLR as an independent prognostic factor for inoperable and surgically resected patients
Biochemical parameters
Zhang et al[7]	302	Serum albumin and BUN levels were found to be independent prognostic factors for prediction of OS
Stocken et al[46]	653	Albumin, ALP, LDH, BUN, and AST were independent prognostic indicators for survival of advanced pancreatic cancer
Haas et al[60]	291	Pretreatment LDH levels were significantly associated with TTP. Baseline LDH,CRP, and bilirubin were significant prognostic factors for OS

mOS: Median overall survival; WBC: White blood cell; PLR: Platelet to lymphocyte ratio; NLR: Neutrophil to lymphocyte ratio; BUN: Blood urea nitrogen; LDH: Lactate dehydrogenase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; TTP: Time to progression; CRP: C-reactive protein; CEA: Carcinoembryonic antigen.

Table 4 Molecular and novel biomarkers as prognostic factors in pancreatic cancer

References	No. of patients	Results
Molecular markers
Neoptolemos et al[64]	48	mOS, 26.2 mo for patients with high hENT1 expression vs 17.1 for those with low hENT1 expression who treated with gemcitabine (P = 0.002)
Sinn et al[68]	160	Strong stromal SPARC expression was associated with worse DFS and OS (strong vs not-strong DFS 9.0 vs 12.6 mo, P = 0.005; OS 19.8 vs 26.6 mo (P = 0.033).Cytoplasmic SPARC expression was also associated with worse patient outcome (positive vs negative DFS 7.4 vs 12.1 mo, P = 0.041; OS 14.1 vs 25.6 mo, P = 0.011) in patients with pancreatic cancer who received gemcitabine as adjuvant CT
Blackford et al[76]	114	mOS,14.2 mo in patients without SMAD4 gene inactivation vs 11.5 mo for those with inactivation (P = 0.006)
Oshima et al[77]	106	Loss of SMAD4 expression was significantly associated with shorter OS and it was found to be an independent prognostic factor for both OS and DFS
Novel biomarkers
Xue et al[86]	106	mOS for patients with a higher NEDD9 expression was significantly shorter than that of patients with lower NEDD9 expression. NEDD9 was an independent factor of poor prognosis
Xia et al[88]	80	A higher FoxM1 expression had a significantly shorter survival time compared to patients with lower FoxM1 expression and FoxM1 was found to be an independent factor for survival

mOS: Median overall survival; DFS: Disease-free survival; hENT1: Human equilibrative nucleoside transporter 1; SPARC: Secreted protein and rich in cysteine; CT: Chemotherapy; FOXM1: Forkhead box M1.