Rising Serum Uric Acid Level Is Negatively Associated with Survival in Renal Cell Carcinoma

Aim and Background: To investigate the association of serum uric acid (SUA) levels along with statin use in Renal Cell Carcinoma (RCC), as statins may be associated with improved outcomes in RCC and SUA elevation is associated with increased risk of chronic kidney disease (CKD). Methods: Retrospective study of patients undergoing surgery for RCC with preoperative/postoperative SUA levels between 8/2005–8/2018. Analysis was carried out between patients with increased postoperative SUA vs. patients with decreased/stable postoperative SUA. Kaplan-Meier analysis (KMA) calculated overall survival (OS) and recurrence free survival (RFS). Multivariable analysis (MVA) was performed to identify factors associated with increased SUA levels and all-cause mortality. The prognostic significance of variables for OS and RFS was analyzed by cox regression analysis. Results: Decreased/stable SUA levels were noted in 675 (74.6%) and increased SUA levels were noted in 230 (25.4%). A higher proportion of patients with decreased/stable SUA levels took statins (27.9% vs. 18.3%, p = 0.0039). KMA demonstrated improved 5- and 10-year OS (89% vs. 47% and 65% vs. 9%, p < 0.001) and RFS (94% vs. 45% and 93% vs. 34%, p < 0.001), favoring patients with decreased/stable SUA levels. MVA revealed that statin use (Odds ratio (OR) 0.106, p < 0.001), dyslipidemia (OR 2.661, p = 0.004), stage III and IV disease compared to stage I (OR 1.887, p = 0.015 and 10.779, p < 0.001, respectively), and postoperative de novo CKD stage III (OR 5.952, p < 0.001) were predictors for increased postoperative SUA levels. MVA for all-cause mortality showed that increasing BMI (OR 1.085, p = 0.002), increasing ASA score (OR 1.578, p = 0.014), increased SUA levels (OR 4.698, p < 0.001), stage IV disease compared to stage I (OR 7.702, p < 0.001), radical nephrectomy (RN) compared to partial nephrectomy (PN) (OR 1.620, p = 0.019), and de novo CKD stage III (OR 7.068, p < 0.001) were significant factors. Cox proportional hazard analysis for OS revealed that increasing age (HR 1.017, p = 0.004), increasing BMI (Hazard Ratio (HR) 1.099, p < 0.001), increasing SUA (HR 4.708, p < 0.001), stage III and IV compared to stage I (HR 1.537, p = 0.013 and 3.299, p < 0.001), RN vs. PN (HR 1.497, p = 0.029), and de novo CKD stage III (HR 1.684, p < 0.001) were significant factors. Cox proportional hazard analysis for RFS demonstrated that increasing ASA score (HR 1.239, p < 0.001, increasing SUA (HR 9.782, p < 0.001), and stage II, III, and IV disease compared to stage I (HR 2.497, p < 0.001 and 3.195, p < 0.001 and 6.911, p < 0.001) were significant factors. Conclusions: Increasing SUA was associated with poorer outcomes. Decreased SUA levels were associated with statin intake and lower stage disease as well as lack of progression to CKD and anemia. Further investigation is requisite.

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The association of rising serum uric acid levels with survival in renal cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.608 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 608-608

Author(s):

Kendrick Yim ◽

Ahmet Bindayi ◽

Rana R. McKay ◽

Reza Mehrazin ◽

Omer Raheem ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Uric Acid ◽

Cell Carcinoma ◽

Serum Uric Acid ◽

Renal Cell ◽

De Novo ◽

Stage Iii ◽

Ckd Stage ◽

All Cause Mortality ◽

Statin Use

608 Background: To investigate the association of serum uric acid (SUA) levels along with statin use in Renal Cell Carcinoma (RCC), as statins may be associated with improved outcomes in RCC and SUA elevation is associated with increased risk of chronic kidney disease (CKD). Methods: Retrospective study of patients undergoing surgery for RCC with preoperative and postoperative SUA levels between 8/2005-8/2014. Increased SUA was defined as > 7mg/dL for males and > 5.7 mg/dL for females. Analysis was carried out between patients with increased postoperative SUA vs. patients with decreased/stable postoperative SUA. Kaplan-Meier analysis (KMA) calculated overall survival (OS). Multivariable analysis (MVA) was performed to identify factors associated with increased SUA levels and all-cause mortality. Results: 905 patients were analyzed. Decreased/stable SUA levels were noted in 675(74.6%) and increased SUA levels were noted in 230(25.4%). A higher proportion of patients with decreased/stable SUA levels took statins (27.9% vs 18.3%, p = 0.004). Increased SUA had significantly greater de novo CKD (38.7% vs. 18.4%, p < 0.001) and proteinuria (30.9% vs. 20.7%, p = 0.002). KMA demonstrated improved 5-year OS for patients with decreased/stable SUA compared to increased SUA for stage I, (93% vs. 60%), stage II (87% vs. 50%), and stage III (88% vs. 62%) RCC (all p < 0.001). MVA revealed that increasing BMI (OR 1.05, p = 0.009), statin use (OR 0.11, p < 0.001), dyslipidemia (OR 2.66, p = 0.004), stage III/IV cancer (OR 1.89, p = 0.015 and OR = 10.78, p < 0.001), and postoperative de novo CKD stage 3 (OR 5.95, p < 0.001) were predictors for increased postoperative SUA levels. MVA revealed increasing BMI (OR 1.09, p = 0.002), increasing SUA (OR = 4.70, p < 0.001), stage IV RCC (OR = 7.7, p < 0.001, and de novo CKD stage 3 (OR 7.07, p < 0.001) to be independent risk factors for worsened all-cause mortality. Conclusions: Increasing SUA post operatively was associated with worsened outcomes in RCC patients. Decreased SUA levels were associated with statin intake and lower stage disease as well as lack of progression to CKD and anemia. Further investigation is requisite.

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Prognosis of hemodialysis patients with progressive aortic stenosis: a prospective cohort study

Renal Replacement Therapy ◽

10.1186/s41100-021-00367-3 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yoriko Horiguchi ◽

Kaoru Uemura ◽

Naoyoshi Aoyama ◽

Shinichi Nakajima ◽

Tomoki Asai ◽

...

Keyword(s):

Aortic Stenosis ◽

Cardiac Death ◽

Hazard Analysis ◽

Hemodialysis Patients ◽

Proportional Hazard ◽

Cardiac Events ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

All Cause Mortality

Abstract Background Whether progressive mild to moderate aortic stenosis in hemodialysis patients influences their prognosis has not been elucidated. This prospective cohort study explored whether progressive aortic stenosis predicted the rate of cardiac events and mortality in those patients. Methods A total of 283 consecutive hemodialysis patients (no aortic stenosis, 248; progressive aortic stenosis, 35) underwent echocardiography for assessment of aortic stenosis, with a median follow-up period of 4.1 years. Study endpoints were cardiac events, all-cause mortality, and cardiac death. Kaplan–Meier analysis and multivariate Cox proportional hazard analysis were performed to estimate cardiac events, all-cause mortality, and cardiac death. Results Cumulative cardiac event rate, all-cause mortality rate, and the rate of cardiac death at 3-year follow-up were 44.9%, 40.5%, and 26.4% in patients with progressive aortic stenosis and 22.1%, 19.0%, and 7.5% in those without aortic stenosis, respectively. Kaplan–Meier analysis demonstrated the cumulative rates of cardiac events and all-cause mortality. And cardiac death was significantly higher in patients with progressive aortic stenosis than in those without aortic stenosis. Multivariate Cox proportional hazard analysis revealed that progressive aortic stenosis was predictive of cardiac events (adjusted hazard ratio 2.47; 95% confidence interval 1.38–4.39) and cardiac death (adjusted hazard ratio 4.21; 95% confidence interval 2.10–8.46). Age, physical activity, C-reactive protein, and serum albumin levels—but not progressive aortic stenosis—predicted all-cause mortality. Conclusions The rates of cardiac events and cardiac death were higher in hemodialysis patients with progressive aortic stenosis than in those without aortic stenosis. Furthermore, progressive aortic stenosis predicted cardiac events and cardiac death. Compared with those without aortic stenosis, patients with progressive aortic stenosis had higher all-cause mortality, which was related to their comorbidities. Trial registration This study was retrospectively registered with University Hospital Medical Information Network Clinical Trials Registry (registration number, UMIN 000024023) at September 12th, 2016.

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Outcomes of definitive radiotherapy (dRT) and chemo-radiotherapy (dCRT) for loco-regionally confined (LRC) adenocarcinoma (ACA) of the esophagus and gastro-esophageal junction (E/GEJ).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.114 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 114-114

Author(s):

Vidhya Karivedu ◽

Michael J. McNamara ◽

Lisa A. Rybicki ◽

Haider Al taii ◽

Davendra Sohal ◽

...

Keyword(s):

Risk Factors ◽

Hazard Analysis ◽

Clinical Stage ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Cleveland Clinic ◽

Stage I ◽

Proportional Hazard ◽

Term Survival ◽

Cox Proportional Hazard

114 Background: Surgery is the cornerstone of curative intent therapy for patients with ACA of the E/GEJ. Many patients (pts) with LRC disease are medically unsuitable for resection, and thus alternative treatment strategies are required. Definitive CRT is a standard of care for esophageal squamous cell carcinoma, but less is known regarding the outcomes for ACA of the E/GEJ. Methods: Through the Cleveland Clinic tumor registry, and under an IRB approved protocol, pts with LRC (clinical stage I-III, AJCC 7th) ACA of the E/GEJ treated with either dRT or dCRT between 7/04 and 12/14 were identified. Overall survival (OS) from the date of diagnosis was the primary endpoint. In univariate analysis, Cox proportional hazard analysis was used to identify risk factors for mortality. On multivariable analysis, stepwise Cox proportional hazard analysis with variable entry criterion p≤0.10 and variable retention criteria p≤0.05 was used to identify risk factors for mortality. Results: From 7/04 to 12/14, 155 pts received definitive non-operative treatment (103 dCRT, 52 dRT). Clinical stage I disease was present in 20 (13.2%); stage II in 40 (26.5%) and stage III in 91 (60.3%) of the pts. Pts who received dCRT were younger (67 v 74 years, p<0.001) and had more advanced clinical stage (p=0.026). Loco-regional recurrence / persistence was the predominant form of treatment failure occurring in 60% of pts (dCRT 54.3%, dRT 71.2%, p=0.044). With a median follow-up of 34.9 months (range 2.0-107.1), the median OS was 17.3 months (15.6m dCRT, 19.8m dRT, p=0.40) and the projected 5 year OS was 11.5% (16.1% dCRT, 4.0% dRT, p = 0.030). On univariable and multivariable analysis, a worse ECOG performance status, increasing clinical T descriptor, and increasing clinical N descriptor were prognostic for a worse OS. After adjusting for these variables, dRT was associated with a worse OS [dRT/dCRT HR 1.79 (1.20-2.68) p=0.005]. Conclusions: Definitive RT/CRT for LRC ACA of the E/GEJ is associated with poor OS. Long-term survival is nonetheless possible in a small number of pts and appears more likely after dCRT.

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Microalbuminuria After Kidney Transplantation Predicts Cardiovascular Morbidity

Frontiers in Medicine ◽

10.3389/fmed.2021.635847 ◽

2021 ◽

Vol 8 ◽

Author(s):

Dana Bielopolski ◽

Ruth Rahamimov ◽

Boris Zingerman ◽

Avry Chagnac ◽

Limor Azulay-Gitter ◽

...

Keyword(s):

Hazard Analysis ◽

Cardiovascular Morbidity ◽

Urine Collection ◽

Proportional Hazard ◽

Cvd Risk ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Cardiovascular Morbidity And Mortality ◽

Independent Association

Background: Microalbuminuria is a well-characterized marker of kidney malfunction, both in diabetic and non-diabetic populations, and is used as a prognostic marker for cardiovascular morbidity and mortality. A few studies implied that it has the same value in kidney transplanted patients, but the information relies on spot or dipstick urine protein evaluations, rather than the gold standard of timed urine collection.Methods: We revisited a cohort of 286 kidney transplanted patients, several years after completing a meticulously timed urine collection and assessed the prevalence of major cardiovascular adverse events (MACE) in relation to albuminuria.Results: During a median follow up of 8.3 years (IQR 6.4–9.1) 144 outcome events occurred in 101 patients. By Kaplan-Meier analysis microalbuminuria was associated with increased rate of CV outcome or death (p = 0.03), and this was still significant after stratification according to propensity score quartiles (p = 0.048). Time dependent Cox proportional hazard analysis showed independent association between microalbuminuria and CV outcomes 2 years following microalbuminuria detection (HR 1.83, 95% CI 1.07–2.96).Conclusions: Two years after documenting microalbuminuria in kidney transplanted patients, their CVD risk was increased. There is need for primary prevention strategies in this population and future studies should address the topic.

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Abstract 201: Gemfibrozil In Combination With Statin Is Associated With Reduction In All Cause Mortality: A Retrospective Cohort Study

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.201 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Sudeep R Aryal ◽

William Newman

Keyword(s):

Coronary Artery ◽

Retrospective Cohort ◽

Bypass Graft ◽

Outcome Variable ◽

Combination Group ◽

Proportional Hazard ◽

Significant Group ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

All Cause Mortality

Objective: Statins and gemfibrozil as individual monotherapy have shown to reduce major cardiovascular events with statins alone reducing all cause mortality. However, it is uncertain whether the combination of statins with gemfibrozil is associated with further reduction in all cause mortality compared to mortality reduction by statins alone. We will examine the hypothesis that combination of gemfibrozil with statin is associated with greater reduction in all cause mortality compared to statin alone. Methods: We performed a retrospective cohort chart review of the VistA database between January 1, 2003 and January 1, 2013 at the Veterans Affairs Healthcare System in Fargo, North Dakota. All veterans greater than or equal to 18 years of age taking either the combination of statin and gemfibrozil or statin alone for a minimum of 12 months were included in the study. The subjects in either group were selected randomly from the pharmacy database, which divided the subjects into statin or combination group. The total sample size was 1800 with 900 subjects in each group. Our primary outcome variable was all cause mortality. The Kaplan Meier Survival curve was drawn for the combination group versus statin alone group. The adjustment for mortality covariates was by the Cox proportional hazard regression. Findings: Statin versus the combination group differed demographically by age (73 ± 11.5 vs 68 ± 11.8), BMI (29.9 ± 50 vs 31.7 ± 5.4), hypertension (72.1% vs 80.9%), diabetes mellitus (33.0% vs 47%), smoking (22% vs 28.2%) and stroke (8.3% vs 5.2%); all P<0.01. The two groups were similar for myocardial infarction, transient ischemic attack, peripheral vascular disease, coronary artery disease, and coronary artery bypass graft outcomes. The all cause mortality difference was 10.2% between statin and the combination group at 10 years (25% vs 14.8%, P<0.0001). The unadjusted Kaplan-Meier analysis over 10 years subsequent to lipid therapy initiation showed a highly significant group difference. Cox proportional hazard adjustment for age, BMI, hypertension, and diabetes revealed persistence of the group difference (P <0.0001). Conclusion: Combination of gemfibrozil with statin is associated with greater reduction in all cause mortality compared to statins alone. Keywords: gemfibrozil, mortality

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Low rather than high mean corpuscular volume is associated with mortality in Japanese patients under hemodialysis

Scientific Reports ◽

10.1038/s41598-020-72765-2 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Hirokazu Honda ◽

Miho Kimachi ◽

Noriaki Kurita ◽

Nobuhiko Joki ◽

Masaomi Nangaku

Keyword(s):

Mean Corpuscular Volume ◽

Japanese Patients ◽

Cubic Spline ◽

Hazard Models ◽

Proportional Hazard ◽

Corpuscular Volume ◽

Proportional Hazard Models ◽

Cox Proportional Hazard ◽

All Cause Mortality ◽

Cox Proportional Hazard Models

Abstract Recent studies have reported that high mean corpuscular volume (MCV) might be associated with mortality in patients with advanced chronic kidney disease (CKD). However, the question of whether a high MCV confers a risk for mortality in Japanese patients remains unclear. We conducted a longitudinal analysis of a cohort of 8571 patients using data derived from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS) phases 1 to 5. Associations of all-cause mortality, vascular events, and hospitalization due to infection with baseline MCV were examined via Cox proportional hazard models. Non-linear relationships between MCV and these outcomes were examined using restricted cubic spline analyses. Associations between time-varying MCV and these outcomes were also examined as sensitivity analyses. Cox proportional hazard models showed a significant association of low MCV (< 90 fL), but not for high MCV (102 < fL), with a higher incidence of all-cause mortality and hospitalization due to infection compared with 94 ≤ MCV < 98 fL (reference). Cubic spline analysis indicated a graphically U-shaped association between baseline MCV and all-cause mortality (p for non-linearity p < 0.001). In conclusion, a low rather than high MCV might be associated with increased risk for all-cause mortality and hospitalization due to infection among Japanese patients on hemodialysis.

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The Association Between Serum Human Epididymis Protein 4 Level and Cardiovascular Events in Patients with Chronic Obstructive Pulmonary Disease

Laboratory Medicine ◽

10.1093/labmed/lmaa076 ◽

2020 ◽

Author(s):

Hui Lin ◽

Jianhong Xiao ◽

Xianghua Su ◽

Bin Song

Keyword(s):

Blood Pressure ◽

Chronic Obstructive Pulmonary Disease ◽

Logistic Regression ◽

Hazard Analysis ◽

Chronic Obstructive ◽

Proportional Hazard ◽

Obstructive Pulmonary Disease ◽

Human Epididymis Protein 4 ◽

Human Epididymis ◽

Cox Proportional Hazard

Abstract Objective Serum human epididymis protein 4 (HE4) is associated with immune and inflammatory responses. This study aimed to assess the performance of serum HE4 in the early detection of cardiovascular (CV) events in patients with chronic obstructive pulmonary disease (COPD). Methods Serum HE4 levels were measured in 199 patients with COPD, all of whom were prospectively followed up for a median period of 36 months (range = 3 months–38 months). Logistic regression analysis was performed to assess the association between cardiovascular disease (CVD) history and HE4 in patients with COPD. Cox proportional hazard analysis was performed to assess the prognostic value of serum HE4 for predicting CV events. Results Serum HE4 levels were higher in patients with COPD with CV events than in those without CV events (252.6 pmol/L [186.4–366.8] vs 111.0 pmol/L [84.8–157.1]; P <.001). The multivariate logistic regression model revealed that serum HE4 (odds ratio = 1.639; 95% confidence interval [CI], 1.213–2.317; Ptrend =.009) was independently associated with CVD history after adjusting for age, sex, body mass index, current smoking status, current alcohol consumption status, admission systolic blood pressure and diastolic blood pressure, hyperlipidemia, left ventricular ejection fraction, primary diseases, and laboratory measurements in patients with COPD at baseline. The multivariate Cox proportional hazard analysis revealed that serum HE4 (hazard ratio = 2.012; 95% CI, 1.773–4.469; P <.001) was an independent prognostic factor for CV events in these patients. The Kaplan-Meier analysis showed that the rate of CV events was higher in patients with COPD with HE4 levels above the median (187.5 pmol/L) than in those with HE4 levels below the median. Conclusion Our results showed that serum HE4 was significantly and independently associated with CVD history and had independent predictive value for CV events in patients with COPD. Serum HE4 may enable early recognition of CV complication development among patients with COPD.

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Intensive Care Unit Admissions in Patients with Hematologic Malignancies: Outcomes and Prognostic Indicators.

Blood ◽

10.1182/blood.v106.11.752.752 ◽

2005 ◽

Vol 106 (11) ◽

pp. 752-752 ◽

Cited By ~ 1

Author(s):

Diana Rubin-Superfin ◽

Timothy Albertson ◽

Carol M. Richman

Keyword(s):

Confidence Interval ◽

Risk Group ◽

Hazard Analysis ◽

Hematologic Malignancies ◽

Hazard Ratio ◽

Prognostic Indicators ◽

Proportional Hazard ◽

Icu Stay ◽

Cox Proportional Hazard ◽

Life Threatening

Abstract With intensification in treatments of hematologic malignancies (HM), the number of life-threatening complications requiring intensive care unit (ICU) admissions has increased. In general, cancer patients requiring ICU care are considered to have a poor prognosis, but it is a common belief among intensivists that patients with HM have an exceptionally grave prognosis. The aim of the current study was to assess outcomes in patients with HM admitted to the ICU for life-threatening complications. In addition, this study intended to identify early prognostic indicators that would be helpful in determining outcomes of ICU stay in this patient population. We performed a retrospective chart review of 185 consecutive critically ill patients with HM admitted to the ICU at a tertiary university hospital during a 5.5-year period. We collected variables ar admission and during admission and identified predictors of in-hospital mortality by Cox proportional hazard analysis. 88.7% patients had active disease, and 36.2% were bone marrow transplant (BMT) recipients. 24.3% were leukopenic (leukocyte count,<1.0x109/L) at admission. Sepsis (30.3%), respiratory failure (17.3%), and post-surgical complications (16.2%) were the major reasons for ICU admissions. 22.2% required vasopressors at admission. 38.4% required mechanical ventilation (MV) and 9.2% needed hemodialysis during ICU stay. Crude ICU, in-hospital, and 6-month mortality rates were 19.5%, 8.1%, and 9.7%, respectively. MV (hazard ratio, 2.75), blood urea nitrogen (BUN)>22 (hazard ratio, 1.81), pre-existent COPD/Asthma (hazard ratio, 3.24), urine output (UOP)<400 ml/24hr (hazard ratio, 2.8) were associated with poor outcome, while high albumin (hazard ratio, 0.54) was associated with better prognosis in multivariate Cox proportional hazard analysis. Using an univariate logistic regression model, diagnosis of acute leukemia (odds ratio, 2.42; 95% confidential interval, 1.23–4.75) or allogeneic BMT (odd ratio, 4.33; 95% confidence interval, 1.17–16.06) were associated with poor outcome, whereas diagnosis of lymphoma (odd ratio, 0.34; 95% confidence interval, 0.16–0.72) or APACHE II<22 (odd ratio, 0.33; 95% confidence interval, 0.17–0.65) were associated with better prognosis. Using these variables, we categorized our population into 4 groups: a very low risk group (lymphoma or other non-leukemia in combination with no need for MV and good UOP/normal BUN), a low risk group (lymphoma or other non-leukemia in combination with either MV, or low UOP/high BUN, or both), an intermediate risk group (leukemia or post-BMT in combination with either MV, or low UOP/high BUN, or neither negative factors), and a high risk group (leukemia or post-BMT in combination with MV and low UOP/high BUN). Survival probabilities at 6 months were 85%, 50%, 47%, and 16%, respectively (p<0.0001). The survival of patients with HM in the ICU was compatible with overall ICU survival at our institution, contrary to prevailing opinion. However, we identified several early predictors of outcome that may be important in deciding on prolonged ICU stay.

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The oncologic impact of pancreatic fistula after pancreatectomy in patients with pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.426 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 426-426

Author(s):

Manabu Kawai ◽

Yoshiaki Murakami ◽

Seiko Hirono ◽

Ken-Ichi Okada ◽

Fuyuhiko Motoi ◽

...

Keyword(s):

Pancreatic Cancer ◽

Pancreatic Fistula ◽

Hazard Analysis ◽

High Volume ◽

Postoperative Management ◽

Proportional Hazard ◽

Term Survival ◽

Long Term Survival ◽

Cox Proportional Hazard

426 Background: There is a few reports that evaluates the association between pancreatic and long-term survival after pancreatectomy in patients with pancreatic cancer. The aim of this study was to elucidate the oncological impact of pancreatic fistula (PF) on long-term survival after pancreatectomy in patients with pancreatic cancer by performing a survey of high volume centers for pancreatic resection in Japan. Methods: Between January 2001 and December 2012, 1,369 patients who underwent pancreatectomy for pancreatic cancer at 7 high-volume centers in Japan were retrospectively reviewed. Results: Pancreatic fistula(PF) occurred in 320 of 1,369 patients (23.5%), and these were classified based ISGPF as follows; grade A in 10.2%, grade B in 10.7%, and grade C in 2.6% of the patients. Median survival time (MST) in no fistula/grade A, grade B and grade C were 24.0, 26.3 and 11.0 months, respectively. MST in grade B PF was similar with that in no fistula/grade A. However, patients with grade C PF had a significantly poorer survival than those without (P<0.001). In the multivariate cox proportional hazard analysis, grade C PF was detected as an independent prognostic factor after pancreatectomy for pancreatic cancer (hazard ratio (HR) 2.15; 95% confidence interval (CI) 1.40-3.29; P< 0.001). Conclusions: Grade C PF adversely affects long-term survival of patients with pancreatic cancer undergoing pancreatectomy, although patients with grade B PF have similar prognosis with no fistula/grade A. Postoperative management to prevent grade C PF is important to improve prognosis in patients with pancreatic cancer undergoing pancreatectomy.

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