Prognostic Markers after Hepatic Function Impairment in Patients with Pancreatic Adenocarcinoma

To determine the factors affecting survival after hepatic failure in patients with pancreatic adenocarcinoma (PAC) who developed hepatic dysfunction accompanied by hyperbilirubinemia.

Observational Study.

Department of Medical Oncology, Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey, from January 2017 to May 2022.

The clinical characteristics of adult patients who developed hepatic dysfunction accompanied by hyperbilirubinemia with a diagnosis of PAC and died in their follow-up were recorded from the hospital's patient registry database. Patients without medical record were excluded. The effective parameters of overall survival after hepatic failure (aHFOS) were determined.

The study included 57 patients with PAC (56.1% males) who developed hepatic dysfunction during their follow-up. According to the CA 19-9 value at the time of diagnosis, the tumour localisation was predicted to be located in the head and neck (Cutoff ≤1400, AUC 0.77, sensitivity 73.2%, specificity 75%; p=0.002). Values of international normalised ratio (INR, p=0.010), blood urea nitrogen (BUN, p=0.002) that were measured during hepatic dysfunction, and tumour location in the head and neck in the pancreas (p=0.028) were determined as independent variables affecting aHFOS in patients with PAC. In addition, percutaneous transhepatic biliary drainage (PTDB) application during liver failure and initiation of chemotherapy in appropriate patients also positively affected aHFOS (2.62 months vs. 0.92 months, p=0.016 and 3.45 months vs. 1.11 months, p=0.003; respectively).

Sufficient liver function reserve in malignant patients is highly effective in the curability and survival of patients. In this regard, it is crucial to improve prognosis by identifying the factors affecting aHFOS in patients with PAC who develop hepatic dysfunction due to liver metastasis or the primary tumour characteristics.

Pancreatic adenocarcinoma, CA 19-9, Hepatic failure, Prognosis, Survival.