Modification of BACAP score as a predictor of pancreatic carcinoma resectability at Dr. Cipto Mangunkusumo National Center Hospital Jakarta

Ahmad Ravles; Agi Satria Putranto; Dhanasari Vidiawati Trisna

doi:10.15562/bmj.v12i2.4502

Modification of BACAP score as a predictor of pancreatic carcinoma resectability at Dr. Cipto Mangunkusumo National Center Hospital Jakarta

Ahmad Ravles ,

Agi Satria Putranto ,

Dhanasari Vidiawati Trisna ,

pdf |
DOI: https://doi.org/10.15562/bmj.v12i2.4502 |
Published: 2023-05-26

Abstract

Link of Video Abstract: https://youtu.be/wBzC28ImZ7Q

Background: Surgery remains the best choice curative treatment for pancreatic cancer. Therefore, it is crucial to establish accurate diagnosis from the beginning. BACAP score and CA 19-9 have been identified as good predictors of pancreatic cancer resectability, and their accuracy is expected to increase when combined. This study aimed to determine the outcomes produced by the combination of the BACAP score and CA 19-9 tumor marker.

Methods: This was retrospective cross-sectional study involved pancreatic cancer patients who underwent surgery between January 2017 and April 2023. Logistic regression analysis was performed on all variables of the BACAP score and CA 19-9. The primary outcomes were demographic characteristics, predictive value of BACAP score, Modified BACAP score, and CA 19-9

Results: A total 87 patients were included. BACAP score yields a sensitivity of 50.0%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 73.8%, and accuracy of 75.9% (AUC 94.6%). While modified BACAP score yielded a sensitivity of 83.1%, specificity of 85.7%, PPV of 70.5%, NPV of 92.5%, and accuracy of 83.9% (AUC 89.4%).

Conclusion: The combination of CA 19-9 and the BACAP score yields a modified score with better outcomes compared to the BACAP score alone in predicting the resectability of pancreatic carcinoma.

References

Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74(11):2913-2921.
Globocan. Incidence, mortality, and prevalence by cancer site in Indonesia [Internet]. 2020. Available from: https://gco.iarc.fr/today/data/factsheets/populations/360-indonesia-fact-sheets.pdf.
Pasihulizan. Hubungan CA 19-9 Praoperasi terhadap Resektabilitas Adenokarsinoma Kaput Pankreas [Tesis]. Jakarta: Fakultas Kedokteran Universitas Indonesia; 2020.
Neuzillet C, Gaujoux S, Williet N, Bachet JB, Bauguion L, Colson Durand L, et al. Pancreatic cancer: French clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC). Dig Liver Dis. 2018;50(12):1257-1271.
Bouvier AM, Uhry Z, Jooste V, Drouillard A, Remontet L, Launoy G, et al; French Network of Cancer Registries (FRANCIM). Focus on an unusual rise in pancreatic cancer incidence in France. Int J Epidemiol. 2017;46(6):1764-1772.
Kommalapati A, Tella SH, Goyal G, Ma WW, Mahipal A. Contemporary management of localized resectable pancreatic cancer. Cancers. 2018;10(1):24.
Rawla P, Sunkara T, Gaduputi V. Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol. 2020;10(1):10–27.
Winter JM, Brennan MF, Tang LH, D'Angelica MI, Dematteo RP, Fong Y, et al. Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Ann Surg Oncol. 2012;19(1):169-175.
Kneuertz PJ, Cunningham SC, Cameron JL, Torrez S, Tapazoglou N, Herman JM, et al. Palliative surgical management of patients with unresectable pancreatic adenocarcinoma: trends and lessons learned from a large, single institution experience. J Gastrointest Surg. 2011;15(11):1917-1927.
Costache MI, Costache CA, Dumitrescu CI, Tica AA, Popescu M, Baluta EA, et al. Which is the best imaging method in pancreatic adenocarcinoma diagnosis and staging-CT, MRI or EUS?. Curr Health Sci J. 2017;43(2):132-136.
Deng Y, Ming B, Wu JL, Zhou T, Zhang SY, Chen Y, et al. Magnetic resonance imaging for preoperative staging of pancreatic cancer based on the 8th edition of AJCC guidelines. J Gastrointest Oncol. 2020;11(2):329-336.
Schima W, Ba-Ssalamah A, Goetzinger P, Scharitzer M, Koelblinger C. State-of-the-art magnetic resonance imaging of pancreatic cancer. Top Magn Reson Imaging. 2007;18(6):421-429.
Maulat C, Canivet C, Touraine C, Gourgou S, Napoleon B, Palazzo L, et al. A new score to predict the resectability of pancreatic adenocarcinoma: The BACAP score. Cancers. 2020;12(4):783.
Marion-Audibert AM, Vullierme MP, Ronot M, Mabrut JY, Sauvanet A, Zins M, et al. Routine MRI with DWI sequences to detect liver metastases in patients with potentially resectable pancreatic ductal carcinoma and normal liver CT: a prospective multicenter study. AJR Am J Roentgenol. 2018;211(5):W217-W225.
Coppola A, Farolfi T, La Vaccara V, Cammarata R, Caputo D. Role of neoplastic markers in pancreatic adenocarcinoma. J Clin Med. 2022;11(21):6509.
Gaddam S, Abboud Y, Oh J, Samaan J, Nissen NN, Lu SC, et al. Incidence of pancreatic cancer by age and sex in the US, 2000-2018. JAMA. 2021;326(20):2075-2077.
Killic M, Göçmen E, Tez M, Ertan T, Keskek M, Koç M. Value of preoperative serum CA 19-9 levels in predicting resectability for pancreatic cancer. Can J Surg. 2006;49(4):241.
Tempero MA. NCCN guidelines updates: pancreatic cancer. J Natl Compr Canc Netw. 2019;17(5.5):603-605.
Springfeld C, Jäger D, Büchler MW, Strobel O, Hackert T, Palmer DH, et al. Chemotherapy for pancreatic cancer. La Presse Medicale. 2019;48(3):e159-e174.
Wang H, Liu J, Xia G, Lei S, Huang X. Survival of pancreatic cancer patients is negatively correlated with age at diagnosis: a population-based retrospective study. Scientific Reports. 2020;10(1):7048.

[1] Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74(11):2913-2921.

[2] Globocan. Incidence, mortality, and prevalence by cancer site in Indonesia [Internet]. 2020. Available from: https://gco.iarc.fr/today/data/factsheets/populations/360-indonesia-fact-sheets.pdf.

[3] Pasihulizan. Hubungan CA 19-9 Praoperasi terhadap Resektabilitas Adenokarsinoma Kaput Pankreas [Tesis]. Jakarta: Fakultas Kedokteran Universitas Indonesia; 2020.

[4] Neuzillet C, Gaujoux S, Williet N, Bachet JB, Bauguion L, Colson Durand L, et al. Pancreatic cancer: French clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC). Dig Liver Dis. 2018;50(12):1257-1271.

[5] Bouvier AM, Uhry Z, Jooste V, Drouillard A, Remontet L, Launoy G, et al; French Network of Cancer Registries (FRANCIM). Focus on an unusual rise in pancreatic cancer incidence in France. Int J Epidemiol. 2017;46(6):1764-1772.

[6] Kommalapati A, Tella SH, Goyal G, Ma WW, Mahipal A. Contemporary management of localized resectable pancreatic cancer. Cancers. 2018;10(1):24.

[7] Rawla P, Sunkara T, Gaduputi V. Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol. 2020;10(1):10–27.

[8] Winter JM, Brennan MF, Tang LH, D'Angelica MI, Dematteo RP, Fong Y, et al. Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Ann Surg Oncol. 2012;19(1):169-175.

[9] Kneuertz PJ, Cunningham SC, Cameron JL, Torrez S, Tapazoglou N, Herman JM, et al. Palliative surgical management of patients with unresectable pancreatic adenocarcinoma: trends and lessons learned from a large, single institution experience. J Gastrointest Surg. 2011;15(11):1917-1927.

[10] Costache MI, Costache CA, Dumitrescu CI, Tica AA, Popescu M, Baluta EA, et al. Which is the best imaging method in pancreatic adenocarcinoma diagnosis and staging-CT, MRI or EUS?. Curr Health Sci J. 2017;43(2):132-136.

[11] Deng Y, Ming B, Wu JL, Zhou T, Zhang SY, Chen Y, et al. Magnetic resonance imaging for preoperative staging of pancreatic cancer based on the 8th edition of AJCC guidelines. J Gastrointest Oncol. 2020;11(2):329-336.

[12] Schima W, Ba-Ssalamah A, Goetzinger P, Scharitzer M, Koelblinger C. State-of-the-art magnetic resonance imaging of pancreatic cancer. Top Magn Reson Imaging. 2007;18(6):421-429.

[13] Maulat C, Canivet C, Touraine C, Gourgou S, Napoleon B, Palazzo L, et al. A new score to predict the resectability of pancreatic adenocarcinoma: The BACAP score. Cancers. 2020;12(4):783.

[14] Marion-Audibert AM, Vullierme MP, Ronot M, Mabrut JY, Sauvanet A, Zins M, et al. Routine MRI with DWI sequences to detect liver metastases in patients with potentially resectable pancreatic ductal carcinoma and normal liver CT: a prospective multicenter study. AJR Am J Roentgenol. 2018;211(5):W217-W225.

[15] Coppola A, Farolfi T, La Vaccara V, Cammarata R, Caputo D. Role of neoplastic markers in pancreatic adenocarcinoma. J Clin Med. 2022;11(21):6509.

[16] Gaddam S, Abboud Y, Oh J, Samaan J, Nissen NN, Lu SC, et al. Incidence of pancreatic cancer by age and sex in the US, 2000-2018. JAMA. 2021;326(20):2075-2077.

[17] Killic M, Göçmen E, Tez M, Ertan T, Keskek M, Koç M. Value of preoperative serum CA 19-9 levels in predicting resectability for pancreatic cancer. Can J Surg. 2006;49(4):241.

[18] Tempero MA. NCCN guidelines updates: pancreatic cancer. J Natl Compr Canc Netw. 2019;17(5.5):603-605.

[19] Springfeld C, Jäger D, Büchler MW, Strobel O, Hackert T, Palmer DH, et al. Chemotherapy for pancreatic cancer. La Presse Medicale. 2019;48(3):e159-e174.

[20] Wang H, Liu J, Xia G, Lei S, Huang X. Survival of pancreatic cancer patients is negatively correlated with age at diagnosis: a population-based retrospective study. Scientific Reports. 2020;10(1):7048.

Modification of BACAP score as a predictor of pancreatic carcinoma resectability at Dr. Cipto Mangunkusumo National Center Hospital Jakarta

Abstract

References

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