Risk stratification and prognostic factors in patients with unresectable undifferentiated carcinoma of the pancreas

Background: Undifferentiated carcinoma (UC) of the pancreas has been considered a highly aggressive malignancy. However, only a few studies have systematically described the clinical course of UC patients. The aim of this study was to clarify the prognosis and construct a prognostic model for patients with unresectable UC. Methods: This study was conducted at 17 institutions in Japan, and a total of 55 patients were analyzed. Results: The median overall survival (OS) of patients with unresectable UC was 3.95 months. In the multivariate Cox proportional hazards (CPH) model, age >65 years, Eastern Cooperative Oncology Group performance status (ECOG PS) >2, and C-reactive protein (CRP) >10 mg/L were independent prognostic factors for OS (age >65 years: hazard ratio [HR], 2.732; 95% confidence interval [CI], 1.353-5.515; ECOG PS > 2: HR, 7.866; 95% CI, 1.981-31.241; CRP >10 mg/L: HR, 1.956; 95% CI, 1.013-3.775). Based on the b coefficients from the CPH model, the prognostic scores were defined as follows: age >65 years (3 points), ECOG PS > 2 (6 points), and CRP >10 ml/L (2 points). The final prognostic model was the sum of the points. The derived prognostic model stratified patients into high-risk (score >4) and low-risk (score 0 -3) groups, with significant differences in OS (1.45 vs. 8.19 months, respectively; p < 0.001). Conclusions: The prognostic model stratified patients into high-risk and low-risk groups. These findings suggest that this model can serve as a tool for patient information and decision-making with regard to the therapeutic strategy for UC. (c) 2021 IAP and EPC. Published by Elsevier B.V. All rights reserved.