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. 2021 Dec;10(24):8934-8943.
doi: 10.1002/cam4.4415. Epub 2021 Nov 22.

Real-world prognostic factors for survival among treated patients with metastatic pancreatic ductal adenocarcinoma

Kenneth H Yu  1 , Muhammet Ozer  2 , Paul Cockrum  3 , Andy Surinach  4 , Shu Wang  4 , Bong Chul Chu  4
Affiliations

Real-world prognostic factors for survival among treated patients with metastatic pancreatic ductal adenocarcinoma

Kenneth H Yu et al. Cancer Med. 2021 Dec.

Abstract

Background: Many real-world studies of patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) are restricted to single centers, limiting the generalizability of their insights. This study aimed to identify important population-based predictors for survival in patients diagnosed with mPDAC in a broader setting.

Methods: Data between 1 January 2017 and 31 December 2019 were extracted from the Flatiron Health EHR database. Treatment-specific predictive models were generated for patients treated with first-line gemcitabine+nab-paclitaxel (GNP), FOLFIRINOX, gemcitabine monotherapy (gem-mono), and second-line liposomal irinotecan-based regimens. The holdout method was used for cross-validation. Age at diagnosis, sex, BMI, smoking status, and ECOG performance score were included in all models with additional demographic, clinical characteristics, and hematological function assessed for inclusion.

Results: Of the 3625 patients, 43% received GNP, 26% received FOLFIRINOX, 7% received gem-mono, and 23% received other regimens; 40% (n = 1448) advanced to the second line. Among all first-line patients, the following were included in the final model: prior surgery, white blood cell (WBC) counts, serum albumin (SA), liver function tests (LFTs), serum bilirubin, serum carbohydrate antigen 19-9, and ascites. Models for patients receiving specific therapies differed from the overall model, GNP (ascites removed), FOLFIRINOX (stage at initial diagnosis added), and gem-mono (LFTs omitted). Alkaline phosphatase (ALP), SA, and WBC counts were important predictors of survival among patients treated with second-line liposomal irinotecan. Across all regimens, the strongest predictors of survival were ECOG score, SA, and ALP.

Conclusions: In this real-world study of patients with mPDAC, important population prognostic factors of survival were identified in a large cohort of patients receiving systemic treatment.

Keywords: antineoplastic agents; electronic health records; pancreatic ductal adenocarcinoma; prognostic factors; real-world evidence; treatment options.

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Conflict of interest statement

KHY receives research funding from Ipsen and Bristol Myers Squibb; MO reports no conflict of interest; PC is an employee and has stock in Ipsen; AS and SW are employees of Genesis Research which receives research funding from Ipsen; BCC was an employee of Genesis Research at the time of the study.

Figures

FIGURE 1
FIGURE 1
Prognostic models were obtained from multivariable Cox regression model. Models were selected based on univariable p value = 0.15 to allow a variable in the model and p value = 0.1 to keep a variable in the model. Exception: The 2L GNP cohort model was based on a p value =0.1 to allow a variable in the model and p value = 0.1 to keep the variable in the model. For models including ALT and AST simultaneously, final model included only ALT. 1L, 2L, and 3L first, second, and third lines of therapy; ALP alkaline phosphatase; ALT, alanine transaminase; AST, aspartate transaminase; BMI, body mass index; ECOG, Eastern Cooperative Oncology Group; Hb1AC, glycosylated hemoglobin; LDH, lactate dehydrogenase; mPDAC, metastatic pancreatic ductal adenocarcinoma
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