Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of Prognostic Factors and Survival Results in Pancreatic Carcinomas in Turkey

  • Canyilmaz, Emine (Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University) ;
  • Serdar, Lasif (Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University) ;
  • Uslu, Gonca Hanedan (Department of Radiation Oncology, Kanuni Research and Education Hospital) ;
  • Soydemir, Gulsen (Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University) ;
  • Bahat, Zumrut (Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University) ;
  • Yoney, Adnan (Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University)
  • Published : 2013.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The goal of this retrospective study was to evaluate patient characteristics, treatment modalities and prognostic factors in Turkish patients with pancreatic cancer. Materials and Methods: Between January 1997 and December 2012, 64 patients who presented to the Department of Radiation Oncology, Karadeniz Technical University, Faculty of Medicine with a diagnosis of pancreatic cancer were evaluated. The E/K ratio of the cases was 2.4/1 and the median age was 59.6 (32-80) years, respectively. Some 11 cases (18%) were stage 1, 21 (34.4%) were stage 2, 10 (16.4%) were stage 3, and 19 (31.1%) were metastatic. Results: The mean follow-up time was 15.7 months (0.7-117.5) and loco-regional recurrence was noted in 11 (40.7%) who underwent surgery while metastases were observed in 41 patients (66.1%). The median overall survival (OS) was 11.2 months and the 1, 3 and 5-year OS rates were 41.7%, 9.9% and 7.9% respectively. The median disease-free survival (DFS) was 5.2 month and the1, 2 and 5 year DFS were 22.6%, 7.6% and 3.8% respectively. On univariate analysis, prognostic factors affecting OS included status of the operation (p<0.001), tumor stage (p=0.008), ECOG performance status (p=0.005) and CEA level (p=0.017).On multivariate analysis, prognostic factors affecting survival included status of the operation (p=0.033) and age (p= 0.023). Conclusions: In the current study, age and operation status were independent prognostic factors for overall survival with pancreatic patients. Thus, the patients early diagnosis and treatment ars essential. However, prospective studies with more patients are needed for confirmation.

Keywords

References

  1. Bayraktar S, Bayraktar UD, Rocha-Lima CM (2010). Recent developments in palliative chemotherapy for locally advanced and metastatic pancreas cancer. World J Gastroenterol, 16, 673-82. https://doi.org/10.3748/wjg.v16.i6.673
  2. Bernhard J, Dietrich D, Glimelius B, et al (2010). Estimating prognosis and palliation based on tumour marker CA 19-9 and quality of life indicators in patients with advanced pancreatic cancer receiving chemotherapy. Br J Cancer, 103, 1318-24. https://doi.org/10.1038/sj.bjc.6605929
  3. Boeck S, Hinke A, Wilkowsky R, et al (2007). Heinemann V. Importance of performance status for treatment outcome in advanced pancreatic cancer. World J Gastroenterol, 13, 224-7. https://doi.org/10.3748/wjg.v13.i2.224
  4. Bramhall SR, Allum WH, Jones AG, et al (1995). Treatment and survival in 13,560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands: an epidemiological study. Br J Surg, 82, 111-5. https://doi.org/10.1002/bjs.1800820137
  5. Brennan MF, Kattan M, Klimstra D, et al (2004). Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg, 240, 293-8. https://doi.org/10.1097/01.sla.0000133125.85489.07
  6. Burris HA, Moore MJ, Andersen J, et al (1997). Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol, 15, 2403-13. https://doi.org/10.1200/JCO.1997.15.6.2403
  7. Conlon KC, Klimstra DS, Brennan MF (1996). Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg, 223, 273-9. https://doi.org/10.1097/00000658-199603000-00007
  8. Evans D, Abbruzzese J, Willett C (2001). Cancer of the pancreas, 6th ed. Philadelphia: Lippincott Williams and Wilkins,
  9. Foo ML, Gunderson LL, Nagorney DM, et al (1993). Paterns of failure in grossly resected pancreatic ductal adenocarcinoma treated with adjuvant irradiation +/- 5 fluorourasil. Int J Radiat Oncol Biol Phys, 26, 483-9. https://doi.org/10.1016/0360-3016(93)90967-Z
  10. Garcea G, Dennison AR, Pattenden CJ, et al (2008): Survival following curative resection for pancreatic ductal adenocarcinoma. A systematic review of the literature. JOP, 9, 99-132.
  11. Gudjonsson B (1995). Carcinoma of the pancreas: critical analysis of costs, results of resections, and the need for standardized reporting. J Am Coll Surg, 181, 483-503.
  12. Gastrointestinal Tumor Study Group (1985). Radiation therapy combined with Adriamycin or 5-fluorourasil for the treatment of locally unresectable pancreatic carcinoma. Cancer, 56, 2563-8. https://doi.org/10.1002/1097-0142(19851201)56:11<2563::AID-CNCR2820561104>3.0.CO;2-0
  13. Gastrointestinal Tumor Study Group (1979). A multi-institutional comparative trial of radiation therapy alone and in combination with 5-fluorouracil for locally unresectable pancreatic carcinoma. Ann Surg, 189, 205-8.
  14. Heinemann V, Boeck S, Hinke A, et al (2008). Meta-analysis of randomized trials: evaluation of benefit from gemcitabine-based combination chemotherapy applied in advanced pancreatic cancer. BMC Cancer, 8, 82 https://doi.org/10.1186/1471-2407-8-82
  15. Huguet F, Andre T, Hammel P, et al (2007). Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol, 25, 326-31. https://doi.org/10.1200/JCO.2006.07.5663
  16. Iacobuzio-Donahue CA, Fu B, et al (2009). DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer. J Clin Oncol, 27, 1806-13. https://doi.org/10.1200/JCO.2008.17.7188
  17. Ishii H, Okada S, Nose H, et al (1996). Prognostic factors in patients with advanced pancreatic cancer treated with systemic chemotherapy. Pancreas, 12, 267-71. https://doi.org/10.1097/00006676-199604000-00009
  18. Jemal A, Siegel R, Ward E, et al (2009). Cancer statistics, 2009. CA Cancer J Clin, 59, 225-49. https://doi.org/10.3322/caac.20006
  19. Klaassen DJ, Maclntyre JM, Catton GE, et al (1985). Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorourasil alone with radiation plus concurrent and maintenance 5-fluorourasil- an Eastern Cooperative Oncology Group study. J Clin Oncol, 3, 373-8. https://doi.org/10.1200/JCO.1985.3.3.373
  20. Kindler HL, Niedzwiecki D, Sutherland S, et al (2010). Gemcitabine plus bevacizumab compared with gemcitabine plus placebo in patients with advanced pancreatic cancer: phase III trial of the Cancer and Leukemia Group B (CALGB 80303). J Clin Oncol, 28, 3617-22. https://doi.org/10.1200/JCO.2010.28.1386
  21. Krishnan S, Rana V, Janjan NA, et al (2006). Prognostic factors in patients with unresectable locally advanced pancreatic adenocarcinoma treated with chemoradiation. Cancer, 107, 2589-96. https://doi.org/10.1002/cncr.22328
  22. Lim JE, Chien MW, Earle CC (2003). Prognostic factors following curative resection for pancreatic adenocarcinoma: a population based, linked database analysis of 396 patients. Ann Surg, 237, 74-85. https://doi.org/10.1097/00000658-200301000-00011
  23. Malik NK, May KS, Chandrasekhar R, et al (2012). Treatment of locally advanced unresectable pancreatic cancer: a 10-year experience. J Gastrointest Oncol, 3, 326-34.
  24. Moertel CG, Childs DS Jr, Reitemeier RJ, et al (1969). Combined 5-fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. Lancet, 2, 865-7.
  25. Mullinax JE, Hernandez JM, Toomey P, et al (2012). Survival after pancreatectomy for pancreatic adenocarcinoma is not impacted by performance status. Am J Surg, 204, 704-8. https://doi.org/10.1016/j.amjsurg.2012.01.016
  26. Neoptolemos JP, Stocken DD, Friess H, et al (2004). A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med, 350, 1200-10. https://doi.org/10.1056/NEJMoa032295
  27. Ozaki H (1992). Improvement of pancreatic cancer treatment from the Japanese experience in the 1980s. Int J Pancreatol, 12, 5-9.
  28. Philip A, Mooney M, Jaffe D, et al (2009). Consensus report of the National Cancer Institute Clinical Trials Planning Meeting on pancreas cancer treatment. J Clin Oncol, 27, 5660-9. https://doi.org/10.1200/JCO.2009.21.9022
  29. Sultana A, Tudur Smith C, Cunningham D, et al (2007). Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy. Br J Cancer, 96, 1183-90. https://doi.org/10.1038/sj.bjc.6603719
  30. Vainshtein JM, Schipper M, Zalupski MM, et al (2012). Prognostic significance of carbohydrate antigen 19-9 in unresectable locally advanced pancreatic cancer treated with dose-escalated intensity modulated radiation therapy and concurrent full-dose gemcitabine: analysis of a prospective phase 1/2 dose escalation study. Int J Radiat Oncol Biol Phys, 86, 96-101
  31. Winter JM, Yeo CJ, Brody JR (2013). Diagnostic, prognostic, and predictive biomarkers in pancreatic cancer. J Surg Oncol, 7, 15-22.
  32. Yeo CJ, Yeo TP, Hruban RH, et al (2005). Cancer of the Pancreas. In: Devita, Vincent T.; Hellman, Samuel; Rosenberg, Steven A. Cancer: Principles and Practice of Oncology, 7th Edition, Lippincott Williams and Wilkins, 947-50 (Beyza-15).
  33. Yovino S, Maidment BW 3rd, Herman JM, et al (2012). Analysis of local control in patients receiving IMRT for resected pancreatic cancers. Int J Radiat Oncol Biol Phys, 83, 916-20. https://doi.org/10.1016/j.ijrobp.2011.08.026

Cited by

  1. Clinical, Laboratory Biomarkers and Imaging Findings of Pancreatic Adenocarcinoma in Iran vol.15, pp.10, 2014, https://doi.org/10.7314/APJCP.2014.15.10.4349
  2. Second-Line Capecitabine and Oxaliplatin Combination for Gemcitabine-Resistant Advanced Pancreatic Cancer vol.15, pp.17, 2014, https://doi.org/10.7314/APJCP.2014.15.17.7119
  3. F-FDG SPECT with Serum Procalcitonin for Identification of Etiology in Tumor Patients with Fever of Unknown Origin vol.15, pp.2, 2014, https://doi.org/10.7314/APJCP.2014.15.2.683
  4. Effects of Secondary Left-sided Portal Hypertension on the Radical Operation Rate and Prognosis in Patients with Pancreatic Cancer vol.15, pp.5, 2014, https://doi.org/10.7314/APJCP.2014.15.5.2239
  5. Expression and Prognostic Significance of lncRNA MALAT1 in Pancreatic Cancer Tissues vol.15, pp.7, 2014, https://doi.org/10.7314/APJCP.2014.15.7.2971
  6. Establishment of a Pancreatic Cancer Stem Cell Model Using the SW1990 Human Pancreatic Cancer Cell Line in Nude Mice vol.16, pp.2, 2015, https://doi.org/10.7314/APJCP.2015.16.2.437
  7. Increased UGT1A3 and UGT1A7 Expression is Associated with Pancreatic Cancer vol.16, pp.4, 2015, https://doi.org/10.7314/APJCP.2015.16.4.1651
  8. Adjuvant chemotherapy followed by concurrent chemoradiation is associated with improved survival for resected stage I-II pancreatic cancer pp.20457634, 2019, https://doi.org/10.1002/cam4.1967