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Mejia A, Vivian E, Shah J, Barrera Gutierrez JC. Albumin-Bilirubin (ALBI) Score and Systemic Immune-Inflammation Indexes Used As Pretreatment Outcome Predictors in Patients With Pancreatic Ductal Adenocarcinoma Undergoing Robotic or Open Whipple Procedures: A Logistic Regression Analysis. Cureus 2023; 15:e50949. [PMID: 38249287 PMCID: PMC10800120 DOI: 10.7759/cureus.50949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer (PC) in the United States. In patients with resectable PC, identification of pretreatment biomarkers before surgery can help in the decision-making process by weighing the benefits of neo-adjuvant therapy, surgical procedure, and adjuvant therapy. The purpose of this study was to determine if the albumin-bilirubin (ALBI) score and immune-inflammatory marker levels can be used in combination as pretreatment predictors of mortality risk in patients undergoing the Whipple procedure (alternatively, pancreatoduodenectomy (PD)) for PDAC. Methods This retrospective study included 115 patients with PDAC who underwent open or robotic Whipple procedures between January 2013 and December 2022 at a single tertiary medical center. Logistic regression analysis was used to find the association between predictors and mortality. Machine learning algorithms were used to calculate the performance of the different models. Results Bivariate analysis showed that the variables "sex" and "body mass index (BMI)" had a potential association with mortality, although statistical significance was not achieved for sex (p = 0.07). Patients with BMIs >25 kg/m2 had a higher risk of mortality compared to patients with BMIs ≤24.9 kg/m2 (odds ratio (OR) = 2.2, 95% CI = 1.03-4.8, p = 0.04). Higher (more positive) ALBI scores (>-2.24) were also associated with increased mortality risk (OR = 4.6, 95% CI = 2-10.5, p = 0.0003). When the cutoff values of the inflammatory markers were used to categorize these variables, values greater than the cutoff values were associated with an increased risk of mortality. In the multivariate logistic regression model, an ALBI score >-2.24 (OR = 4.3, 95% CI = 1.8-10.3, p = 0.0008), neutrophil-to-lymphocyte ratio (NLR) >3.5 (OR = 3.3, 95% CI = 1.4-7.9, p = 0.007), and being a woman (OR = 2.6, 95% CI = 1.1-6.4, p = 0.03) remained influential predictors of increased mortality (c value = 0.77). Conclusion The ALBI score and the NLR are easily accessible markers; their use, combined with a patient's sex, can provide useful pre-surgical information regarding mortality risk after PD. This can aid in treatment planning as well as expedite decisions about the type of Whipple procedure, adjuvant therapy, and surveillance, which can subsequently improve a patient's outcomes and survival.
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Affiliation(s)
- Alejandro Mejia
- Surgery, The Liver Institute, Methodist Dallas Medical Center, Dallas, USA
| | - Elaina Vivian
- Performance Improvement, Methodist Dallas Medical Center, Dallas, USA
| | - Jimmy Shah
- Performance Improvement, Methodist Dallas Medical Center, Dallas, USA
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Höhn P, Runde F, Luu AM, Fahlbusch T, Fein D, Klinger C, Uhl W, Belyaev O, Keck T, Werner J, Nüssler N, Bartsch DK, Germer CT, Friess H, Mönch C, Oldhafer KJ, Kalff JC. Applicability of the surgical risk calculator by the American College of Surgeons in the setting of German patients undergoing complete pancreatectomy: multicentre study using data from the StuDoQ|Pancreas registry. BJS Open 2023; 7:7071649. [PMID: 36882081 PMCID: PMC9991503 DOI: 10.1093/bjsopen/zrac164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/16/2022] [Accepted: 11/12/2022] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Surgical risk calculators can estimate risk probabilities for postoperative outcomes utilizing patient-specific risk factors. They provide meaningful information for obtaining informed consent. The aim of the present paper was to evaluate the predictive value of the surgical risk calculators by the American College of Surgeons in German patients undergoing total pancreatectomy. METHODS Data for patients who underwent total pancreatectomy between 2014 and 2018 were acquired from the Study, Documentation, and Quality Center of the German Society for General and Visceral Surgery. Risk factors were entered manually into the surgical risk calculators and calculated risks were compared with actual outcomes. RESULTS Of the 408 patients analysed, predicted risk was higher in patients with complications except for the prediction of re-admission (P = 0.127), delayed gastric emptying (P = 0.243), and thrombosis (P = 0.256). In contrast, classification of patients into below, above, or average risk by the surgical risk calculators only produced meaningful results for discharge to nursing facility (P < 0.001), renal failure (P = 0.003), pneumonia (P = 0.001), serious complications, and overall morbidity (both P < 0.001). Assessment of discrimination and calibration showed poor results (scaled Brier scores 8.46 per cent or less). CONCLUSION Overall surgical risk calculator performance was poor. This finding promotes the development of a specific surgical risk calculator applicable to the German healthcare system.
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Affiliation(s)
- Philipp Höhn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Fabian Runde
- Faculty of Medicine, Ruhr-Universität Bochum, Bochum, Germany
| | - Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Tim Fahlbusch
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Daniel Fein
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Carsten Klinger
- StuDoQ Registry, German Society for General and Visceral Surgery, Berlin, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Orlin Belyaev
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | | | - Tobias Keck
- Surgical Department, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Jens Werner
- Department of General, Visceral, Transplant, Vascular and Thoracic Surgery, Klinikum Großhadern, Ludwig-Maximilians-Universität München, München, Germany
| | - Natascha Nüssler
- Department of General and Visceral Surgery, Endocrine Surgery und Coloproctology, Klinikum Neuperlach, Städt. Klinikum München, München, Germany
| | - Detlef K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Universitätsklinikum Marburg, Marburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Vascular and Pediatric Surgery, Universitätsklinik Würzburg, Würzburg, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Christian Mönch
- Department of General, Visceral and Transplant Surgery, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany
| | | | - Jörg C Kalff
- Department of Visceral, Colorectal Surgery and Proctology, Universitätsklinikum Bonn, Bonn, Germany
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