Evaluation of Treatment for Advanced Pancreatic, Cancers -Hospital Free Survival andQuality-Adjusted Survival Analysis as an Objective Indicator for QOL-

Junichi Sakamoto, Mitsunori Yasue, Kenzo Yasui, Takeshi Morimoto, Seiichi Miyashi, Hiroaki Nakazato

Department of Gastroenterological Surgery, Aichi Cancer Center

To evaluate the total benefit of the multidisciplinary treatment for TNM Stage III (N=58) and Stage IV (N=94) pancreatic cancers who underwent laparotomy in Aichi Cancer Center from 1975 through 1990, the overall survival time was divided into 1) period of postoperative hospitalization (POH), 2) hospital-free survival (HFS) and 3) hospitalization period after systemic relapse (REL) were analysed. POH and REL were adjusted by coefficients of utility in quality of life relatives to HFS and the results were calculated to give a period of quality adjusted survival time relatives to HFS (Q-HFS). From the questionnaires given to pancreatic cancer patients and to the attendants of the 9th meeting of the society for survival time studies on cancer patients, utility coefficients for POH and REL were determined as -0.5 and 0 respectively, relative to+1.0 for HFS. Benefits measured by Q-HFS significantly favored pancreatectomy in Stage III patients. However, no difference in Q-HFS was observed between patients with and without pancreatectomy in Stage IV patients although there was a significant difference in overall survival according to the generalized Wilcoxon test (p=0.039). From these results, we postulate that quality-adjusted survival analysis might be useful in assessing the advantages and disadvantages of extensive surgery as well as of toxic adjuvant therapy.

Key words
advanced pancreas cancer, hospital free survival, quality-adjusted survival analysis

Reprint requests
Junichi Sakamoto Department of Gastroenterological Surgery, Aichi Cancer Center
1-1 Kanokoden, Chikusa-ku, Nagoya, 464 JAPAN

Accepted
July 6, 1992

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