Fatores prognósticos no adenocarcinoma ductal da cabeça do pâncreas após ressecção com intenção curativa

Abstract

Pancreatic ductal adenocarcinoma represents 2% of all types of cancer and 4% of deaths due to neoplasia in Brazil. Surgical resection is the only curative therapeutic option. The aim of this study was to identify prognostic factors in patients with ductal adenocarcinoma of the head of the pancreas, who underwent surgical treatment with curative intent. From 2005 to 2018, clinico-demographic, laboratory, perioperative and histopathological data were prospectively collected. Survival analysis was performed by the Kaplan-Meier method and the comparison between the curves by the log-rank test. For the multivariate analysis, the Cox regression model was used. The patients' ages ranged from 34 to 89 years (mean 60.1 years, standard deviation 12 years, median 59.5 years). The factors with impact on survival in the univariate analysis were age 70 years (p=0.012), previous cancer history (p=0.026) and Clavien-Dindo postoperative complications III and IV (p=0.015). In the multivariate analysis, patients with preoperative serum CA 19.9 level between 38 and 554 U/ml had a 3.15 times higher chance of death than those with normal level (HR 3.15; 95% CI 1.01 - 9,82; p=0.047), whereas patients with the marker above 554 U/ml had 3.96 times greater chance of death (HR 3.96; 95% CI 1.19 - 13.10; p=0.024). Patients with comorbidities had 2.90 times greater chance of death than patients without other associated conditions (HR 2.90; 95% CI 1.10 - 7.67; p=0.032). In conclusion, ductal adenocarcinoma of the pancreas head is an aggressive disease, for which the worst prognostic factors were advanced age, presence of comorbidities, previous history of cancer, high serum CA 19.9 levels and major postoperative complications.