Gaining a new angle on pancreas cancer: A pre-operative thrombelastographic parameter predicts recurrence and survival among patients with resected periampullary and pancreatic adenocarcinoma

• Published in: The American journal of surgery 2024-12, Vol.238, p.115820, Article 115820
• Main Authors: Schulick, Alexander C., Moore, Hunter B., Franco, Salvador Rodriguez, Jiang, Jessie G., Edil, Barish H., Schulick, Richard D., Nydam, Trevor L., McCarter, Martin D., Del Chiaro, Marco, Gleisner, Ana
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenocarcinoma - blood; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Ampulla of Vater - pathology; Ampulla of Vater - surgery; Biomarkers; Cancer; Chemotherapy; FDA approval; Female; Humans; Lymphatic system; Male; Middle Aged; Multivariate analysis; Neoplasm Recurrence, Local - blood; Neoplasm Recurrence, Local - epidemiology; Pancreas; Pancreatectomy; Pancreatic cancer; Pancreatic Neoplasms - blood; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Patients; Performance evaluation; Predictive Value of Tests; Regression analysis; Regression models; Retrospective Studies; ROC Curve; Statistical analysis; Statistical methods; Surgery; Survival; Survival Rate; Thrombelastography; Tumors
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.115820

It has previously been demonstrated that Thrombelastography(TEG) angle may be associated with recurrence and survival in pancreas cancer in a cohort of patients operated on at the University of Colorado in 2016–2017. Now approaching 10 years of follow-up, we revisit these associations and strengthen these claims with multivariate analysis. Retrospective chart review was performed. Statistical analysis was conducted using STATA. Receiver operating characteristic(ROC) curves identified the performance of angle for predicting recurrence&survival. Unadjusted and adjusted cox regression models were used to identify significant predictors of these outcomes. 47 patients were included with median follow-up of 29.6 months. ROC curves for angle predicting recurrence and survival identified a cutoff of 44.5°. KM curves demonstrated that patients above the cutoff were more likely to recur(90%vs46 ​%,p ​= ​0.001) and less likely to survive(16%vs56 ​%,p ​= ​0.001). Angle remained significant on multivariate analyses (HR recurrence:3.64[1.32–10.25],HR survival:3.80[1.38–10.46]). TEG angle is independently associated with disease recurrence and overall survival in pancreas cancer. This may be identifying virulent tumor biology, but further studies are required. A prospective study is underway. •TEG may be used to predict clinical outcomes in pancreas cancer.•TEG Angle ≥44.5° is associated with greater recurrence risk.•Angle ≥44.5° is also associated with lower overall survival.•It remains an independent predictor on multivariate analysis.