Cancer of the pancreas. Diagnostic accuracy and survival statistics

Abstract

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. This study shows the necessity for standardization of reporting methods. The same patients and survivors should not be used repeatedly in different reports. Some authors who claim the most effective palliation by pancreatic resection have the highest mortality rates.Cancer 42:2494-2506, 1978.ANCER OF THE PANCREAS, a malignancy C difficult to recognize or treat, has apparently so increased in frequency as to account for 2 1,800 deaths in the United States in 1977' and is now the fourth leading cause of death from cancer among men. The age adjusted mortality rate from pancreatic cancer in the United States has risen from 2.9 per 100,000 in 1920 to 9 per 100,000 in 1970,57,58 an increase of over 300%. In our own state, the Connecticut Tumor Registry has shown an incidence of pancreatic cancer of 6.9 per 100,000 in men in 1935 to 1939,19 9.9 in 1968,20 and 12 Accepted for publication February 3, 1978. dence and any increased survival after therapy. In order to have a base for our clinical impressions, we reviewed the natural history, diagnosis and survivorship of patients with pancreatic cancer in the state of Connecticut. MATERIALS A N D METHODST o establish a convenient data base, we investigated the fate of 100 patients with histologically proven adenocarcinoma of the pancreas, and we selected the years 1960-1971 for our review. The criteria for selection were: 1) histologic proof of the lesion, and 2) operative or autopsy localization of the primary tumor in the pancreas. In some patients with a pancreatic mass, in whom the diagnosis depended upon lymph node or liver biopsy, the site of pancreatic cancer was substantiated at laparotomy or confirmed by autopsy. In order to find 100 records which fulfilled the foregoing criteria, 197 records of patients with a discharge diagnosis of pancreatic cancer had to be scrutinized. The implication of this will be discussed later. Follow-up, ranging from one month to eight years and eleven months, was possible in 97 of the 100 histologically proven cases. The findings in this series were then compared to published results in a thorough literature review.

A prospective randomised controlled trial of tamoxifen and cyproterone acetate in pancreatic carcinoma

“…When the entire group of patients was considered, without taking anti-hormonal treatment into consideration, the survival of those patients who underwent biliary bypass survival was 5.4 months, a figure almost identical to that reported in other large series (Gudjonsson et al, 1978) and better than either drug treatment or stenting. This presumably reflects the poorer prognosis of patients with tumours of the body and tail (Carter & Commis, 1975) who do not require relief of obstructive jaundice, and the choice of a stenting procedure in poor risk patients considered unfit for surgical bypass.…”

Epidemiology and diagnosis of the pancreatic cancer: Epidemiología y diagnóstico

“…Many reviews report a prolonged period of time between symptom onset and diagnosis (32,33). This parameter is being questioned of late, as delays have been dramatically shortened.…”

“…CT scans may demonstrate a mass within the pancreas, metastatic disease of the liver and both the periaortic and retropancreatic lymph nodes, and the presence of ascites. Clearly identified cystic changes, with or without calcification, suggest a cystdenoma or cystdenocarcinoma (32). Improved imaging techniques provide more accurate staging, which has an impact on preoperative decision making regarding tumor resectability (43,44).…”

“…Múltiples trabajos exponen el dilatado espacio de tiempo que transcurre entre el comienzo de los síntomas y el diagnóstico (32,33). Este parámetro comienza a ser cuestionado, dado que se esta acortando extraordinariamente ese espacio.…”

Histogenesis of pancreatic carcinogenesis in the hamster: ultrastructural evidence.

“…The human disease carries a poor prognosis (7)(8)(9), mainly due to the difficulty of early detection. It appears to be associated with environmental factors and industrialization (10,11).…”