OBJECTIVE: Discrepancies exist between reported actuarial and actual 5 year survival rates for pancreatic adenocarcinoma. Our objective was to determine the actual 5 year survival rate of patients with pancreatic adenocarcinoma who underwent a resection with curative intent in 5 hospitals in Toronto. We then sought to determine clinical and histopathological features of 5 year survivors to determine factors associated with a more favourable prognosis.
METHODS: A retrospective chart review was performed using surgeon and hospital databases to identify patients who had a surgical resection (Whipple, total or distal pancreatectomy) for pancreatic adenocarcinoma between 1988 and Dec 31,1995.
RESULTS: Using the above search strategy, 106 patients from seven surgical practices were identified who had a resection and a pathologic diagnosis of pancreatic adenocarcinoma. Mean survival for all patients was 30.3±3.6 months. There are seventeen 5-year survivors (15.2%) including 4 patients (3.6%) who survived >10 years. The survivors included 12 patients with a Whipple resection, 4 with a distal pancreatectomy, and 1 with a total pancreatectomy. Four of the 5-year survivors died of recurrent pancreatic cancer at 60,62,79 and 106 months and 3 died of other causes. Ten patients are still alive at a mean of 110.8±9.8 months after surgery. In univariate analysis, tumour size<2.5 cm, negative lymph nodes, well-differentiated histology, lack of duodenal invasion and cancers outside the head of the pancreas were all associated with a significant survival advantage(all p<0.05 by Fisher's exact test). In multivariate Cox proportional hazard modeling, only node negative disease and well-differentiated cancers were independently associated with significantly improved survival. The 5-year survival rate by nodal status and grade were: N0 35.2±6.5% vs N1 17.6±5.9% (p=0.0008 by Log Rank) and well differentiated 50.0±11.8% vs moderately or poorly-differentiated 22.3±4.7% (p=0.01)
CONCLUSIONS: We conclude that pancreatic adenocarcinoma is occasionally curable if it is well differentiated and identified in its early stages. These, and other similar data should provide further stimulus for the development and evaluation of novel screening strategies, especially for those subjects with inherited predisposition to the disease.
