Cancer of the pancreas: diagnostic accuracy and survival statistics.
Gudjonsson B, Livstone EM, Spiro HM, Cancer 1978
Nov;42(5):2494-506
We have reviewed the natural history, reliability of diagnosis, and survivorship of 100
patients with adenocarcinoma of the pancreas, in the context of a thorough review of the
literature on survival after therapy for adenocarcinoma of the pancreas. There is
40--62.5% error in the histologic confirmation of the diagnosis of pancreatic cancer. The
error by inspection and palpation alone at the time of surgery may be as great as 25%. The absolute 5 year
survival rate calculated from 61 clinical studies representing approximately 15,000
patients is 0.4%. The best series in the current
literature has only 3% 5 year rate based upon the total population of pancreatic
cancer patients. 12.3% of 5 year survivors from the world literature did not have
curative surgery.
Cancer of the pancreas. 50 years of surgery.
Gudjonsson B, Cancer 1987 Nov 1;60(9):2284-303
Yale University School of Medicine, New Haven, Connecticut.
The course of 196 patients with proven carcinoma of the pancreas seen at Yale New Haven
Hospital from 1972 to 1982 was analyzed. Only 73% of the patients were preoperatively
expected to have cancer of the pancreas. The patients who underwent resection had the
longest mean survival but also the longest total hospital stay. Twenty-seven patients
survived 1 year or more, but nonresected patients constituted 81.5% of this group. The
only 5-year survivor did not undergo resection. Forty-seven percent of patients who
survived 1 year and had not undergone gastroduodenal bypass, developed duodenal
obstruction. It was not possible to identify a subset of patients with a favorable
prognosis. A review totaling approximately 37000 patients, of whom 4100 had undergone
resections, revealed only 156 survivors, 12 of whom had not been resected, for an overall
survival rate of only 0.4%. No author had more than 3.4% of the total number of patients
as 5-year survivors.
Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really
improving?
Nitecki SS, Sarr MG, Colby TV, van Heerden JA, Ann Surg
1995 Jan;221(1):59-66
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
OBJECTIVE: The authors review their recent experience with resected pancreatic ductal
adenocarcinoma. SUMMARY BACKGROUND DATA: Ductal adenocarcinoma of the pancreas has traditionally had a 5-year survival rate less than 10% after
curative resection. Recently, several groups
have reported markedly improved 5-year survival rates (approaching 25%) for
patients undergoing curative resection. METHODS: Institutional experience with 186
consecutive patients (1981-1991) with pathologic diagnoses of ductal adenocarcinoma
undergoing pancreatic resection was reviewed. Histologic specimens of all 3-year survivors
(n = 31) were re-reviewed by two pathologists, one internal and one external; nonductal
pancreatic cancers then were excluded. RESULTS: After histologic re-review, 12 patients
did not have ductal adenocarcinoma, leaving a total of 174 patients for analysis (102 men,
72 women; mean age 63 years, range 34-82 years). Mean follow-up was 22 months (range
4-109). Classical pancreaticoduodenectomy was performed in 71%, pylorus-preserving
resection in 9%, and total pancreatectomy in 20%. Hospital mortality was 3%. Twenty-eight
patients (16%) had macroscopically incomplete resections; 98 (56%) had lymph node
metastases within the resected specimens, and 21 patients (12%) had extensive perineural
invasion. Overall actuarial
5-year survival was 6.8%.Five-year survival was greater for node-negative versus
node-positive patients (14% vs. 1%,), and for smaller (< 2 cm) versus larger tumors
(20% vs. 1%,). The 5-year survival for the subset of patients with negative nodes and no
perineural or duodenal invasion (69 patients) was 23%. Mean survival of the
12 excluded patients was 53 +/- 7 months compared with 17.5 +/- 1 months in the 174
patients with ductal pancreatic cancer. CONCLUSIONS: Five-year survival for patients
undergoing pancreatic resection for lesions deemed to be clinically "curable"
intraoperatively and histologically reviewed/confirmed to be ductal adenocarcinoma of the
pancreas is approximately 7%. Survival is greater (23%) in the subset of patients with
negative nodes and no duodenal or perineural invasions. Pathologic review of all patients
with pancreatic ductal cancer adenocarcinoma is mandatory if survival data are to be
meaningful.Long-term survival after curative
resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year
survivors.
Conlon KC, Klimstra DS, Brennan MF Ann Surg
1996 Mar;223(3):273-9
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021,
USA.
OBJECTIVE: The authors reviewed the clinicopathologic characteristics of patients who
underwent resection with curative intent for ductal adenocarcinoma of the pancreas between
1983 and 1989. SUMMARY BACKGROUND DATA: Recent studies have demonstrated a reduction in
the morbidity and mortality of pancreatic resection and improvement in the actuarial
5-year survival for patients with resected ductal adenocarcinoma. METHODS: Resection with
curative intent was performed on 118 of 684 patients (17%) with pancreatic cancer admitted
to the authors' institution. Clinical, demographic, treatment, and pathologic variables
were analyzed. The original material for all cases was reviewed; nonductal cancers were
excluded. RESULTS: The head of the gland was the predominant tumor site (n = 102),
followed by the body (n = 9), and tail (n = 7). Seventy-two percent of the patients
underwent pancreaticoduodenectomies, 15% underwent total pancreatectomies, 10% underwent
distal pancreatectomies, and 3% underwent distal subtotal pancreatectomies. Operative
mortality was 3.4%. Median survival was 14.3 months after resection compared with 4.9
months if patients did not undergo resection (p < 0.0001). Twelve patients
survived 5 years after surgery (10.2% overall actual 5-year survival rate).
Three of the tumors were well differentiated, five were moderately differentiated, and
four were poorly differentiated. Extrapancreatic invasion occurred in nine cases (75%),
and perineural invasion was present in ten cases (83%). Five tumors exhibited invasion of
duodenum, ampulla of Vater, and/or common bile duct, and an additional tumor invaded the
portal vein. Lymph node involvement by carcinoma was noted in five cases (42%). Six
patients remain alive without evidence of disease at a median follow-up of 101 months
(range, 82-133 months). Five patients died of recurrent or metastatic pancreatic cancer at
60, 61, 62, 64, and 64 months, respectively. One patient died at 84 months of metastatic
lung cancer without evidence of recurrent pancreatic disease. CONCLUSIONS: This paper
emphasizes the grim prognosis of pancreatic ductal adenocarcinoma. Five-year survival
cannot be equated to cure. Although pancreatectomy offers the only chance for long-term
survival, it should be considered as the best palliative procedure currently available for
the majority of patients. This emphasizes the need for the development of novel and
effective adjuvant therapies for this disease.
Results of 1001 pancreatic resections for invasive ductal
adenocarcinoma of the pancreas.
Hirata K, Sato T, Mukaiya M, Yamashiro K, Kimura M, Sasaki K, Denno R
Arch Surg 1997 Jul;132(7):771-6; discussion 777
First Department of Surgery, Sapporo Medical University School of Medicine, Japan.
OBJECTIVE: To evaluate the recent results of pancreatic resection in patients with
invasive ductal adenocarcinoma of the pancreas. DESIGN: Retrospective study. SETTING:
Seventy-seven medical facilities belonging to the Japan Society of Pancreatic Surgery.
PATIENTS: One thousand one patients who underwent a resection of the pancreas between
January, 1, 1991, and December 31, 1994. MAIN OUTCOME MEASURES: Morbidity and survival
after surgery for pancreatic cancer according to the modified TNM classification of the
International Union Against Cancer. RESULTS: After pancreatic resection, the cumulative
postoperative survival rates
at 1 and 3 years were 44.5% and 10.3%, respectively. Patients with
early-stage cancers had a more prolonged survival time, ie, the cumulative 3-year survival
rates for patients with stage I or stage II cancers were 50.4% and 45.5%, respectively;
the survival rates for patients with stage III and stage IVa and IVb cancers were 17.6%,
5.7%, and 0%, respectively. The survival rate for patients with N1 or N2 metastasis did
not differ appreciably, and both groups had significantly better survival rates than
patients with N3 metastasis (P < .001). A significant difference in the postoperative
survival time of N1 metastasis was observed between patients with no lymph node dissection
(mean survival, 326.4 days) and patients who received a lymph node dissection (D1) (mean
survival, 478.2 days) (P < or = .01). CONCLUSIONS: The recent results of pancreatic
resection for invasive ductal adenocarcinoma of the pancreas are generally unsatisfactory.
Although the outcome of the patients with an N1 metastasis can be improved if they receive
N1 lymph node dissection (D1), an extensive lymph node dissection in advanced cancers does
not necessarily produce a favorable prognosis. |
