Jamal Mohammed H, Doi Suhail A R, Moser A James, Dumitra Sinziana, abou Khalil Jad, Simoneau Eve, Chaudhury Prosanto, Onitilo Adedayo A, Metrakos Peter, Barkun Jeffrey S
Mohammed H Jamal, Sinziana Dumitra, Jad abou Khalil, Eve Simoneau, Prosanto Chaudhury, Peter Metrakos, Jeffrey S Barkun, Hepato-biliary, Pancreatic and Liver Transplant Surgery, McGill University Health Center, Montreal QCH3A 1A1, Canada.
World J Gastroenterol. 2014 Sep 14;20(34):12226-32. doi: 10.3748/wjg.v20.i34.12226.
To evaluate the ability of the McGill Brisbane Symptom Score (MBSS) to predict survival in resectable pancreatic head adenocarcinoma (PHA) patients.
All PHA patients (n = 83) undergoing pancreaticoduodenectomy at the McGill University Health Center, Quebec between 1/2001-1/2010 were evaluated. Data related to patient and cancer characteristics, MBSS variables, and treatment were collected; univariable and multivariable survival analyses were performed. We obtained complete follow-up until February 2011 in all patients through the database of the provincial health insurance plan of Quebec. The unique health insurance numbers of these patients were used to retrieve information from this database which captures all billable clinical encounters, and ensures 100% actual survival data.
Median survival was 23 mo overall: 45 mo for patients with low MBSS, 17 mo for high MBSS (P = 0.005). At twelve months survival was 83.3% (95%CI: 66.6-92.1) vs 58.1% (95%CI: 42.1-71.2) in those with low vs high MBSS, and 24 mo survival was 63.8% (95%CI: 45.9-77.1) and 34.0% (95%CI: 20.2-48.2) respectively. In the multivariate Cox model (stratified by chemotherapy), after addition of clinically meaningful covariates, MBSS was the variable with the strongest association with survival (HR = 2.63; P = 0.001). Adjuvant chemotherapy interacted with MBSS category such that only high MBSS patients accrued a benefit. In univariate analysis we found a lower mortality in high MBSS but not low MBSS patients receiving adjuvant chemotherapy. This interaction variable, on Cox model, resulted in an adjusted mortality HR for the high MBSS (compared to low MBSS) of 4.14 (95%CI: 1.48-11.64) without chemotherapy and 2.11 (95%CI: 1.06-4.17) with chemotherapy.
The MBSS is a simple prognostic tool for resectable PHA. Preoperative categorization of patients according to the MBSS allows effective stratification of patients to guide therapy.
评估麦吉尔布里斯班症状评分（MBSS）预测可切除性胰头腺癌（PHA）患者生存的能力。
对2001年1月至2010年1月在魁北克麦吉尔大学健康中心接受胰十二指肠切除术的所有PHA患者（n = 83）进行评估。收集与患者和癌症特征、MBSS变量及治疗相关的数据；进行单变量和多变量生存分析。通过魁北克省医疗保险计划数据库，我们获得了所有患者直至2011年2月的完整随访信息。利用这些患者唯一的健康保险号码从该数据库中检索信息，该数据库记录了所有可计费的临床诊疗情况，并确保了100%的实际生存数据。
总体中位生存期为23个月：MBSS低的患者为45个月，MBSS高的患者为17个月（P = 0.005）。MBSS低的患者与高的患者在12个月时的生存率分别为83.3%（95%CI：66.6 - 92.1）和58.1%（95%CI：42.1 - 71.2），24个月时的生存率分别为63.8%（95%CI：45.9 - 77.1）和34.0%（95%CI：20.2 - 48.2）。在多变量Cox模型（按化疗分层）中，加入具有临床意义的协变量后，MBSS是与生存关联最强的变量（HR = 2.63；P = 0.001）。辅助化疗与MBSS类别存在交互作用，只有MBSS高的患者能从中获益。在单变量分析中，我们发现接受辅助化疗的MBSS高的患者死亡率较低，但MBSS低的患者并非如此。在Cox模型中，这个交互变量使得MBSS高的患者（与MBSS低的患者相比）在未进行化疗时调整后的死亡HR为4.14（95%CI：1.48 - 11.64），在进行化疗时为2.11（95%CI：1.06 - 4.17）。
MBSS是一种用于可切除性PHA的简单预后工具。根据MBSS对患者进行术前分类可实现患者的有效分层，以指导治疗。
