# Prognostic Impact of Unplanned Hospitalization During First-Line Gemcitabine Plus Nab-Paclitaxel Therapy for Unresectable Pancreatic Cancer: A Single-Center Retrospective Observational Study

## TL;DR

Unplanned hospitalizations during chemotherapy for pancreatic cancer are linked to shorter survival, especially when caused by cancer progression or biliary obstruction.

## Contribution

This study identifies unplanned hospitalization as an independent predictor of poor survival in pancreatic cancer patients undergoing first-line chemotherapy.

## Key findings

- Unplanned hospitalization occurred in 40.2% of patients and was associated with significantly shorter median survival (10.88 vs. 19.23 months).
- Hospitalization due to cancer progression or recurrent biliary obstruction was linked to worse survival outcomes.
- Pancreatic head tumor location was identified as a risk factor for unplanned hospitalization.

## Abstract

Unresectable pancreatic cancer is usually treated with combination chemotherapy using gemcitabine and nab-paclitaxel. During treatment, some patients suddenly need to be admitted to hospital because of cancer progression, infections, or treatment-related problems. It is unclear how such unplanned hospitalizations affect patient survival in real-world practice. In this single-center study, we reviewed the medical records of patients who started gemcitabine plus nab-paclitaxel as their first treatment for unresectable pancreatic cancer. We compared survival between patients who experienced at least one unplanned hospitalization during treatment and those who did not. We also examined the main reasons for admission. We found that unplanned hospitalization, especially due to cancer progression or recurrent biliary obstruction, was associated with shorter survival. These findings may help clinicians identify vulnerable patients earlier, support clinical decision-making, and optimize supportive care during chemotherapy.

Background: Pancreatic cancer (PC) is a refractory malignancy with a dismal prognosis. For unresectable PC, gemcitabine plus nab-paclitaxel (GnP) is widely used as first-line chemotherapy. During treatment, patients may require unplanned hospitalization (UPH) due to tumor progression, biliary obstruction, or chemotherapy-related adverse events. Although UPH during chemotherapy may be linked to poorer survival, its prognostic impact as a time-dependent clinical event during active treatment has not been empirically evaluated in unresectable PC. We investigated the prognostic impact of UPH occurring during first-line GnP therapy. Objective: To clarify the association between UPH during first-line GnP and overall survival (OS). Methods: We retrospectively analyzed 189 patients with histologically confirmed unresectable PC who received first-line GnP at our institution between February 2016 and February 2023. The occurrence of UPH during GnP and the reason for the first UPH were categorized. Associations with OS were assessed using the Kaplan–Meier method and Cox proportional hazards models, including a time-varying covariate (TVC) analysis. Risk factors for UPH were examined with logistic regression. Results: UPH occurred in 76 patients (40.2%) during GnP. Pancreatic head tumors and pre-treatment biliary drainage were significantly more frequent in the UPH group. Median OS was 10.88 months in the UPH group versus 19.23 months in the non-UPH group; UPH was a significant adverse prognostic factor (hazard ratio [HR] 1.97, p < 0.01). In multivariable analysis incorporating a TVC, UPH remained an independent predictor of worse prognosis (HR 3.02, p < 0.01). Reasons for first UPH were progression (n = 28), recurrent biliary obstruction (RBO; n = 26), GnP-related adverse event (AE; n = 16), and other (n = 6). Hospitalization due to progression or RBO was associated with poorer survival. Pancreatic head location was identified as a risk factor for UPH. Conclusions: UPH during first-line GnP is an independent adverse prognostic factor in patients with unresectable PC, even after accounting for TVC. In pancreatic head cancer, closer monitoring for biliary and obstructive complications may be particularly important during treatment.