The prognostic effect of clinical staging in pancreatic adenocarcinoma.
BACKGROUND
The importance of pancreatic cancer staging is uncertain. The aim of this report was to evaluate the accuracy of combined standard imaging techniques in predicting the pathologic stage and to evaluate the prognostic effect of clinical staging to identify patient groups in which laparoscopy and laparotomy could be beneficial.


METHODS
Fifty-four patients were included in this analysis. The techniques used for clinical staging were endoscopic retrograde cholangiopancreatography, abdominal computed tomographic scan, and ultrasonography. All patients underwent both clinical and surgical/pathologic staging. A comparison was performed between presurgical stage and surgical/pathologic stage. The prognostic effect of different factors on survival was evaluated with both univariate (log-rank) and multivariate (Cox) analysis.


RESULTS
Sensitivity and specificity for vascular involvement were 73.9% and 96.3%, respectively. Sensitivity and specificity for nodal involvement were 63.6% and 95.4%, respectively. A total of 33.3% of patients showed a higher than expected pathologic stage, and 3.7% showed a lower than expected pathologic stage, by comparing clinical and pathologic evaluation. A highly significant correlation was observed between clinical T stage (P = .0067) and tumor diameter (P = .0037) and patient survival. Maximal prognostic differentiation was observed by dividing patients into two groups based on imaging results: group A (favorable prognosis) and group B (unfavorable prognosis). The median survival was 25.1 and 8.0 months for group A and B, respectively. Five-year survival was 20.1% and 0%, respectively (multivariate analysis: P = .0007).


CONCLUSIONS
Integrated standard imaging studies achieved reasonable diagnostic accuracy in our analysis. A single classification based on clinical stage and tumor diameter evaluated by imaging predicts prognosis in patients with pancreatic carcinoma.
Morganti
Alessio G
AG
Department of Radiotherapy, Centro di Ricerca e Formazione ad Alta Tecnologia nelleScienze Biomediche, Universitá Cattolica del S. Cuore, Contrada Tappino, 86100 Campobasso, Italy.
Brizi
M Gabriella
MG
Macchia
Gabriella
G
Sallustio
Giuseppina
G
Costamagna
Guido
G
Alfieri
Sergio
S
Mattiucci
Gian Carlo
GC
Valentini
Vincenzo
V
Natale
Luigi
L
Deodato
Francesco
F
Mutignani
Massimiliano
M
Doglietto
G Battista
GB
Cellini
Numa
N
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D019043:Vascular Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary