title: The prognostic effect of clinical staging in pancreatic adenocarcinoma.
abstract: 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.
authors.affiliation: Department of Radiotherapy, Centro di Ricerca e Formazione ad Alta Tecnologia nelleScienze Biomediche, Universitá Cattolica del S. Cuore, Contrada Tappino, 86100 Campobasso, Italy.
authors.forename: Alessio G
authors.initials: AG
authors.lastname: Morganti
authors.forename: M Gabriella
authors.initials: MG
authors.lastname: Brizi
authors.forename: Gabriella
authors.initials: G
authors.lastname: Macchia
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Sallustio
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.forename: Sergio
authors.initials: S
authors.lastname: Alfieri
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Mattiucci
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.forename: Luigi
authors.initials: L
authors.lastname: Natale
authors.forename: Francesco
authors.initials: F
authors.lastname: Deodato
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mutignani
authors.forename: G Battista
authors.initials: GB
authors.lastname: Doglietto
authors.forename: Numa
authors.initials: N
authors.lastname: Cellini
mesh_terms: 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