Predictors of systemic chemotherapy contraindication in pancreatic cancer patients with distant metastasis

Background/Aims: To investigate predictors of systemic chemotherapy contraindication in pancreatic cancer patients with distant metastasis. Methodology: Eighty-seven consecutive pancreatic cancer patients with distant metastasis receiving systemic chemotherapy using 5-fluorouracil, cisplatin or gemcitabine were analyzed retrospectively to investigate prognostic factors. Results: The overall median survival time of all patients in the whole series was 3.8 months, the 3-, 6, and 12-month probability of survival being 58%, 26%, and 3%, respectively. Significant poor prognostic factors were the age of 65 years old or older, presence of ascites, a total bilirubin >2.5mg/dL, ChE <110 IU/L, a higher level of tumor maker (CA19-9) and performance status <80 (p<0.005). Cox proportional hazards model revealed independent poor prognostic factors were a presence of ascites, serum ChE level <110 IU/L, and age ≥65. A prognostic index was calculated based on the regression coefficients derived from the three variables according to their relative risk of death (RRD) = exp (presence of ascites x 1.213 + serum ChE level x 1.065 + age ≥ 65 x 0.651). Conclusions: Ascites, ChE <110 IU/L, or age ≥65 should be chemotherapy contraindications for pancreatic cancer patients with distant metastasis because of their extremely short survival time and some other experimental approaches or supportive care are needed.