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. 2014 Feb;16(2):150-6.
doi: 10.1111/hpb.12094. Epub 2013 Apr 22.

Jaundice: an important, poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas

Steven M Strasberg  1 , Feng Gao, Dominic Sanford, David C Linehan, William G Hawkins, Ryan Fields, Danielle H Carpenter, Elizabeth M Brunt, Carolyn Phillips
Affiliations

Jaundice: an important, poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas

Steven M Strasberg et al. HPB (Oxford). 2014 Feb.

Abstract

Objectives: Jaundice impairs cellular immunity, an important defence against the dissemination of cancer. Jaundice is a common mode of presentation in pancreatic head adenocarcinoma. The purpose of this study was to determine whether there is an association between preoperative jaundice and survival in patients who have undergone resection of such tumours.

Methods: Thirty possible survival risk factors were evaluated in a database of over 400 resected patients. Univariate analysis was used to determine odds ratio for death. All factors for which a P-value of <0.30 was obtained were entered into a multivariate analysis using the Cox model with backward selection.

Results: Preoperative jaundice, age, positive node status, poor differentiation and lymphatic invasion were significant indicators of poor outcome in multivariate analysis. Absence of jaundice was a highly favourable prognostic factor. Interaction emerged between jaundice and nodal status. The benefit conferred by the absence of jaundice was restricted to patients in whom negative node status was present. Five-year overall survival in this group was 66%. Jaundiced patients who underwent preoperative stenting had a survival advantage.

Conclusions: Preoperative jaundice is a negative risk factor in adenocarcinoma of the pancreas. Additional studies are required to determine the exact mechanism for this effect.

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Figures

Figure 1
Figure 1
Kaplan–Meier curve for overall survival in the entire set of patients (n = 412)
Figure 2
Figure 2
Kaplan–Meier curves for overall survival in subgroups of patients categorized according to nodal (N) status and the presence or absence of jaundice (P < 0.001). N1, lymph node metastasis present; N0, lymph node metastasis absent; J1, jaundice present; J0, jaundice absent
Figure 3
Figure 3
Kaplan–Meier curves for overall survival in stented (in endoscopic retrograde cholangiography) and non-stented patients (P = 0.005)
See this image and copyright information in PMC

Comment in

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