Published online Sep 14, 2014. doi: 10.3748/wjg.v20.i34.12226
Revised: February 10, 2014
Accepted: May 28, 2014
Published online: September 14, 2014
Processing time: 317 Days and 8.9 Hours
AIM: To evaluate the ability of the McGill Brisbane Symptom Score (MBSS) to predict survival in resectable pancreatic head adenocarcinoma (PHA) patients.
METHODS: All PHA patients (n = 83) undergoing pancreaticoduodenectomy at the McGill University Health Center, Quebec between 1/2001-1/2010 were evaluated. Data related to patient and cancer characteristics, MBSS variables, and treatment were collected; univariable and multivariable survival analyses were performed. We obtained complete follow-up until February 2011 in all patients through the database of the provincial health insurance plan of Quebec. The unique health insurance numbers of these patients were used to retrieve information from this database which captures all billable clinical encounters, and ensures 100% actual survival data.
RESULTS: Median survival was 23 mo overall: 45 mo for patients with low MBSS, 17 mo for high MBSS (P = 0.005). At twelve months survival was 83.3% (95%CI: 66.6-92.1) vs 58.1% (95%CI: 42.1-71.2) in those with low vs high MBSS, and24 mo survival was 63.8% (95%CI: 45.9-77.1) and 34.0% (95%CI: 20.2-48.2) respectively. In the multivariate Cox model (stratified by chemotherapy), after addition of clinically meaningful covariates, MBSS was the variable with the strongest association with survival (HR = 2.63; P = 0.001). Adjuvant chemotherapy interacted with MBSS category such that only high MBSS patients accrued a benefit. In univariate analysis we found a lower mortality in high MBSS but not low MBSS patients receiving adjuvant chemotherapy. This interaction variable, on Cox model, resulted in an adjusted mortality HR for the high MBSS (compared to low MBSS) of 4.14 (95%CI: 1.48-11.64) without chemotherapy and 2.11 (95%CI: 1.06-4.17) with chemotherapy.
CONCLUSION: The MBSS is a simple prognostic tool for resectable PHA. Preoperative categorization of patients according to the MBSS allows effective stratification of patients to guide therapy.
Core tip: The McGill Brisbane Symptom Score (MBSS) was described and validated as a score to predict survival in patients with unresectable pancreatic adenocarcinoma. In this paper we validate it in a cohort of patients with resectable pancreatic head adenocarcinoma. It is a simple yet powerful preoperative tool that can potentially guide therapy and stratify patients for neoadjuvant or adjuvant chemotherapy trials. We also found in this study that adjuvant chemotherapy seems to be effective only in patients in the high MBSS group but adds no additional survival benefit in patients in the low MBSS group. The MBSS seems to provide a better discrimination in survival than any conventional preoperative method.