The Charlson age comorbidity index predicts early mortality after surgery for pancreatic cancer

Although operative resection represents the only hope for cure in pancreatic cancer, it is associated with significant morbidity and mortality. Furthermore, in some patients disease progression occurs very early postoperatively and no tangible benefit is seen from the operation. Identification of preoperative predictors of death within the first year of surgery could help in the counseling of patients diagnosed with pancreatic cancer.

We studied retrospectively patients who underwent resection for pancreatic adenocarcinoma from 2002 to 2012. We calculated the age-adjusted Charlson Age Comorbidity Index (CACI) and used logistic regression models to determine predictors of mortality within 1 year of surgery. Kaplan-Meier curves and Cox proportional hazards models were developed to determine hazard ratios on survival.

Surgery with curative intent was performed in 497 patients; 136 (27%) died within the first year. A CACI score of >4 was predictive of increased duration of stay (P < .001), postoperative complications (P = .042), and mortality within 1 year of pancreatic resection (P < .001). A CACI score of ≥ 6 increased 3-fold the odds of death within the first year.

CACI is useful to predict outcome after pancreatectomy for pancreatic cancer. Patients with a high CACI score have a <50% likelihood of being alive 1 year postoperatively. This information should be used when considering the appropriateness of pancreatic resection in patients with multiple comorbidities.