Association between Preoperative Exercise Tolerance, Comorbidities, and Survival Rates in Patients with Pancreatic Cancer

Abstract

Introduction: Despite treatment advancements, pancreatic cancer continues to have the lowest 5-year survival rate and a high age-adjusted mortality. Limited physical and functional reserves often restrict therapeutic options. Although the 6-minute walk distance (6MWD) and the Charlson Comorbidity Index (CCI) are established prognostic markers, their combined prognostic utility remains unexplored. This study evaluated the prognostic value of a composite index (6MWD-CCI) in patients who underwent pancreatic resection.

Methods: This retrospective study included 85 patients with pancreatic cancer who underwent resection between July 2019 and September 2022. Preoperative 6MWD (<400 m) and CCI scores were used to classify patients into three 6MWD-CCI risk groups (low, middle, and high). Physical, nutritional, and frailty parameters were also assessed. Kaplan-Meier and Cox regression analyses were performed to evaluate survival outcomes, adjusting for confounders.

Results: During a median follow-up of 802 days, 27 patients (31.8%) died. Low 6MWD, high CCI, and elevated 6MWD-CCI risk levels were significantly associated with reduced survival. The composite 6MWD-CCI demonstrated strong prognostic value, outperforming individual metrics even after adjustment for confounders.

Conclusions: The 6MWD-CCI is a practical and predictive tool for pancreatic cancer prognosis, integrating physical function and comorbidity burden to enhance risk stratification. Its incorporation into clinical workflows could improve preoperative planning. Validation through larger studies is recommended.