Predictors and Diagnostic Strategies for Early-Stage Pancreatic Ductal Adenocarcinoma: A Retrospective Study.
OBJECTIVE
As a strategy to diagnose early-stage pancreatic ductal adenocarcinoma (PDAC) is urgently needed, we aimed to clarify characteristics of early-stage PDAC.


METHODS
We retrospectively reviewed medical records of 299 consecutive patients who underwent R0 or R1 surgical resection for PDAC between 1994 and 2013 and compared clinical characteristics between patients with early-stage (stages 0-I by Japanese General Rules for Pancreatic Cancer) and advanced-stage (stages II-IV) disease. Diagnostic processes were also analyzed.


RESULTS
Twenty-four patients (8%) had early-stage PDAC (stage 0: 11; stage I: 13). Univariate and multivariate analyses showed that presence or history of intraductal papillary mucinous neoplasm (P < 0.01), history of pancreatitis (P < 0.01), and presence or history of extrapancreatic malignancies (P = 0.01) independently predicted detection of early-stage PDAC. Cytological examination during endoscopic retrograde pancreatography cytology was ∼65% sensitive in preoperative diagnosis of early-stage PDAC, whereas other imaging modalities were only 29% to 38% sensitive; 9 of 24 early-stage PDACs were diagnosed by endoscopic retrograde pancreatography cytology alone.


CONCLUSIONS
Endoscopic retrograde pancreatography cytology for patients with intraductal papillary mucinous neoplasm or pancreatitis may help diagnose early-stage PDAC. Surveillance of extrapancreatic malignancies might also provide opportunities to detect early-stage PDAC as a second malignancy.
From the Departments of *Surgery and Oncology, †Anatomic Pathology, ‡Medicine and Bioregulatory Science, and §Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Hideyo
H
Kimura
Takao
T
Ohtsuka
Taketo
T
Matsunaga
Yusuke
Y
Watanabe
Koji
K
Tamura
Noboru
N
Ideno
Teppei
T
Aso
Tetsuyuki
T
Miyazaki
Takashi
T
Osoegawa
Shinichi
S
Aishima
Yoshihiro
Y
Miyasaka
Junji
J
Ueda
Yasuhiro
Y
Ushijima
Hisato
H
Igarashi
Tetsuhide
T
Ito
Shunichi
S
Takahata
Yoshinao
Y
Oda
Kazuhiro
K
Mizumoto
Masao
M
Tanaka
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D003131:Combined Modality Therapy; D003581:Cytodiagnosis / Q000379:methods; D003952:Diagnostic Imaging / Q000379:methods; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity