Malignant ascites in pancreatic cancer: Pathophysiology, diagnosis, molecular characterization, and therapeutic strategies

Han, Margaret; Borazanci, Erkut

doi:10.3389/fonc.2023.1138759

Cited by 7 publications

(6 citation statements)

References 60 publications

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“…Any amount of ascites has been previously identified as a poor prognostic marker in patients with PDAC receiving chemoradiation therapy most likely because this finding indicates peritoneal carcinomatosis ( 10 ). Lymphatic obstruction by metastatic tumor has been proposed as a potential cause of malignant ascites ( 6 , 7 , 14 , 18 ) and bears further investigation in patients with PDAC as an explanation for portal hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…Ascites in patients with gastrointestinal malignancy is relatively understudied compared with ascites in ovarian cancer, despite having a prevalence of up to 15% (2,3). Malignant ascites has been associated with poor prognosis in patients with cancer especially those with nonovarian cancer, although data on malignant ascites in patients with PDAC remain limited (2,(4)(5)(6)(7)(8)(9)(10). Current standard of care focuses on the palliation of symptoms with (oftentimes serial) large volume paracentesis, indwelling catheter placement, shunts, intraperitoneal chemotherapy or systemic cancer therapy, and sometimes diuretics (2,6,8,(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

“…Malignant ascites has been associated with poor prognosis in patients with cancer especially those with nonovarian cancer, although data on malignant ascites in patients with PDAC remain limited (2,(4)(5)(6)(7)(8)(9)(10). Current standard of care focuses on the palliation of symptoms with (oftentimes serial) large volume paracentesis, indwelling catheter placement, shunts, intraperitoneal chemotherapy or systemic cancer therapy, and sometimes diuretics (2,6,8,(11)(12)(13)(14). Malignant ascites in pancreatic cancer is challenging to manage because there are no current guideline recommendations for ascites management in pancreatic cancer (13,15), but guidelines are desperately needed due to the high rate of complications associated with catheter placement and oftentimes poor outcomes in this group of patients despite current efforts in treatment (11,12).…”

Section: Introductionmentioning

confidence: 99%

“…The serum-ascites albumin gradient (SAAG) is of particular importance in the diagnosis of ascites in PDAC ( 6 ) because it may inform whether the etiology of the ascites is likely due to peritoneal carcinomatosis (low SAAG) or portal hypertension (high SAAG) which can determine prognosis and treatment strategies ( 16 , 17 ). Little is known about the relationship between portal hypertension and ascites in PDAC; potential causes of portal hypertension in this population include either those that are liver related (existing cirrhosis and Budd-Chiari syndrome) or nonliver related (lymphatic obstruction or portal vessel invasion by tumor, heart failure, or portal fibrosis) ( 6 , 7 , 16 ). Recent studies have reported evidence of portal hypertension–related ascites despite a lack of liver metastases or disease in a significant subset of patients with PDAC ( 2 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

“…In this group, diuretics have been observed to be inconsistently used at proper doses despite reports of clinical efficacy and being a first-line treatment consideration ( 16 , 18 ). To the best of our knowledge, there are no clinical studies of diuretics in pancreatic cancer–associated ascites, and practicing oncologists rely on empirical therapy or guidelines for ascites due to cirrhosis ( 6 , 16 , 19 ).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Ascites Is a Poor Prognostic Factor in Advanced Pancreatic Adenocarcinoma and May Be Undertreated: A Prospective Cohort Study

Wang,

Cui,

Osipov

et al. 2024

Clin Transl Gastroenterol

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Pancreatic ductal adenocarcinoma (PDAC) is associated with significant morbidity and mortality as most patients present with advanced disease. The development of ascites has been associated with poor outcomes and further characterization and contemporary management strategies are needed. 437 patients enrolled in the Gastrointestinal Biobank at Cedars-Sinai Medical Center who had epithelial pancreatic malignancy were included in the prospective cohort group. 41.7% of patients included in the study developed ascites. The majority (>80%) of ascites patients had high serum-ascites albumin gradient (SAAG) ascites. In both univariate and multivariate analysis, history of >=1 form of chemotherapy was significantly associated with ascites. Estimated median OS in patients with ascites was significantly lower than in patients without ascites, 473 days vs. 573 days, and ascites had a HR of 1.37. Patients with ascites who received diuretics and indwelling peritoneal catheter had an estimated median survival of 133 days from diagnosis of ascites, and those that received only the indwelling peritoneal catheter without diuretics had an estimated median survival of only 54 days. The estimated median survival from the diagnosis of ascites was 92 days and median time to puncture was 7 days. Median time from first tap to death was 45 days. The use of diuretics is lower than would be expected for PDAC patients with elevated SAAG. Other therapies such as beta blockers should be investigated in this subset of patients. The etiology of ascites in these patients is poorly understood and further research is needed to establish treatment guidelines and improve outcomes.

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