EUS and cytological EUS-FNA prognostic factors in patients with unresectable pancreatic cancer receiving chemotherapy.
OBJECTIVE
The incidence of pancreatic cancer is increasing. It is usually diagnosed in an advanced stage despite the improvement in diagnostic techniques. The current study was designed to prospectively analyze several demographic and tumour related variables identified by EUS and EUS-FNA cytology that may affect survival in patients with unresectable pancreatic cancer receiving chemotherapy.


METHODS
The study prospectively included 72 patients diagnosed with pancreatic cancer. Only patients without surgery were selected. All the patients received chemotherapy with the same drug (5-FU). They underwent power Doppler EUS followed by EUS-FNA in all cases. The following information obtained by EUS and EUS-FNA cytology were prepared for inclusion in multivariate survival analysis (tumour localization, portal vein invasion, power Doppler signals presence, collateral circulation, signs of chronic pancreatitis, T and N status, nuclear atypia, nuclear enlargement, pleomorphism, nuclear/cytoplasm ratio, and coarse chromatin).


RESULTS
The entire included population was analyzed to identify factors affecting prognosis. The overall Cox model had a significance level of p = 0.032. There were three factors that had a major impact on the survival time of the patients: regional lymph node involvement (p = 0.029), nuclear pleomorphism (p = 0.037) and nuclear enlargement (p = 0.019).


CONCLUSIONS
The current pre-treatment evaluation of the pancreatic cancer patients by EUS and EUS-FNA could offer some valuable information for appreciation of patients' future evolution. However, extensive studies are required for a complex prognosis scoring system.
Gheonea
Dan Ionuţ
DI
Research Centre of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania. digheonea@gmail.com
Săftoiu
Adrian
A
Popescu
Carmen
C
Ciurea
Tudorel
T
Iordache
Sevastiţa
S
Filip
Monalisa
M
Maloş
Anca
A
D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D044963:Biopsy, Fine-Needle; D019160:Endosonography; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D018084:Ultrasonography, Interventional
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil