[Value of combined therapy in pancreatic cancer with a poor prognosis: analysis of 233 clinical cases].
OBJECTIVE
To analyze the value of combined therapy in pancreatic cancer with a poor prognosis.


METHODS
The prognostic factors of pancreatic cancer with different clinicopathological characteristics and treatment modalities were analyzed retrospectively and the cumulative curve was plotted using the Kaplan-Meier method.


RESULTS
(1) From January 2001 to December 2005, 233 patients with pathological and cytological diagnosis of pancreatic cancer were analyzed. The median survival of all patients was 8.67 months, the 1-year survival rate 29.6% and the 5-year survival rate 4.5%. (2) Weightloss cases had a median survival of 7.7 months versus 10.0 months for cases without weightloss (P = 0.003). Back pain cases had a median survival of 6.5 months versus 9.0 months for cases without back pain (P = 0.015). Cases with normal CA19-9 levels (< or = 37 U/ml) had a median survival of 11.0 months versus 8.0 months for cases with CA19-9 > 37 U/ml levels (P = 0.000). Stages III and IV disease cases had a median survival of 8.7 and 6.3 months versus 16.0 months for cases of Stages I + II (P = 0.000). In the present study, patients suffering from weightloss or back pain or whose CA19-9 was above 37 U/ml or whose TNM stage was III/IV were defined as cases with a poor prognosis. (3) Patients were grouped as pancreatectomy group, cancer-directed treatment group (including intraoperative iodine-125 seed interstitial brachytherapy, 5-FU interstitial chemotherapy, radiotherapy, chemotherapy and transcatheter arterial infusion chemotherapy) and no cancer-directed treatment group (including cases receiving biopsies or bypass). Median survival of three groups were 14.0, 8.3 and 6.6 months respectively. And the 1-year survival rates were 53.5%, 22.5% and 11.8% respectively while the 5-year survival rate 5.8%, 0 and 0 respectively. (4) Median survival of poor prognostic cases (who suffered from weightloss or back pain or whose CA19-9 was above 37 U/ml or whose TNM stage was III/IV) treated with pancreatectomy were 12.0, 11.0, 12.0 and 7.0 months respectively. Median survival of poor prognostic cases treated with cancer-directed therapy were 7.7, 7.5, 8.6 and 8.0 months respectively. Median survival of poor prognostic cases treated with no cancer-directed therapy were 4.0, 3.0, 4.0 and 4.6 months respectively.


CONCLUSIONS
Optimized combined therapy is recommended for pancreatic cancer patients with poor prognostic factors.
Wang
Yi
Y
Department of Abdominal Surgery, Cancer Hospital and Institute, Chinese Academy of Medical Sciences, Beijing 100021, China.
Zhao
Ping
P
Wang
Cheng-feng
CF
Shan
Yi
Y
Zhao
Dong-bing
DB
Tian
Yan-tao
YT
Sun
Yue-min
YM
Che
Xu
X
Zhang
Jian-wei
JW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult