The prognostic factors in patients with pancreatic adenocarcinoma

Objectives: Pancreatic adenocarcinoma has a very poor prognosis. It is the fifth leading cause of cancer-related death in the developed countries. Surgery remains the only potentially curative treatment, but only about 10-20% of patients present with surgically resectable disease. Despite surgery with a curative intent, the 5-year survival rate for these patients remains at approximately 20% and most will usually develop metastatic disease within the first year of therapy. Because of the high relaps rate after curative surgery, the majority of patients with pancreatic cancer are potential candidates for systemic therapy. The aim of the present work is to identify the prognostic factors in patients with resected and also advanced pancreatic adenocarcinoma.Method: We included 207 patients (89 resected, 118 advanced) with pancreatic adenocarcinoma diagnosed and treated at Dokuz Eylul University Faculty of Medicine, Division of Medical Oncology between 1998-2009. The medical records of these patients were retrospectively reviewed, the treatment regimens, the response evaluation, and the side effects of the treatment were recorded.Results: The median overall survival of the patients with resected pancreatic cancer was 13.2 months. Although the median overall survival of the patients with adjuvant treatment (15.2 months) was higher than the patients without adjuvant treatment (9.3 months), the difference in survival was not found statistically significant (p=0.7). We observed that the stage and size of the tumor, histologic differentiation, surgical margine, perineural invasion, lymphatic invasion, and vascular invasion were significantly associated with survival of the patients (p<0.05). Of 89 resected patients with pancreatic carcinoma, 66 patients (%74.1) developed local recurrence or distant metastasis. Of 66 patients with recurrent disease, 44 patients received chemotherapy whose progression free survival were 3.16 months. We found that low performance status, presence of tumor related symptoms, weight loss, low hemoglobin and serum albumin level, elevated ALT level, and absence of chemotherapy in metastatic disease were found to be negatively associated with outcomes (p<0.05).While 26.3% of the patients with advanced pancreatic cancer did not receive any chemotherapy regimen, 73.7% and 17.8% of the patients received 1st line and 2nd line chemotherapy, respectively. The median progression free survival after 1st line chemotherapy was 2.6 months and progressive disease was observed in 87.4% of the patients. The median overall survival was 4.4 months, 6- and 12-month survival rates were 40% and 22%,respectively. While the median overall survival of the patients with chemotherapy was 5.63 months, it was only 2.27 months in patients without chemotherapy (p<0.001). The smoking history, presence of liver metastasis, low performance status, weight loss, presence of ascites, elevated levels of Ca 19-9, AST, ALT, ALP, and GGT, low levels of serum albumin and hemoglobin, high leucocyte count, absence of 1st and 2nd line chemotherapy were found to be negatively associated with outcomes (p<0.05).Conclusion: Many factors could be used as predictors of survival in patients with pancreatic adenocarcinoma. Because of the chemotherapy is associated with increased survival, it should be offered to all eligible patients.Key Words: pancreatic carcinoma, prognostic factors