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Predictors and Diagnostic Strategies of Early Stage Pancreatic Ductal Adenocarcinoma: a Retrospective Review
Hideyo Kimura*, Takao Ohtsuka, Taketo Matsunaga, Yusuke Watanabe, Koji Tamura, Noboru Ideno, Teppei Aso, Yoshihiro Miyasaka, Junji Ueda, Shunichi Takahata, Kazuhiro Mizumoto, Masao Tanaka
Department of Surgery and Oncology, Graduate School of Medical Sciences Kyushu University, Fukuoka-city, Japan
Background: Pancreatic cancer is the fifth cause of cancer death in Japan. Survivors after resection of pancreatic ductal adenocarcinoma (PDAC) have been gradually increasing, while most PDACs are still diagnosed at advanced stages. To improve the prognosis of the patients with PDACs, establishment of the strategy for early diagnosis is urgently needed. The aim of this study was to clarify the characteristics and diagnostic processes of early stage PDACs.
Method: Medical records of consecutive 299 patients who underwent curative resection (R0, R1) for PDACs between 1994 and 2013 were retrospectively reviewed. Clinical characteristics were compared between early stage (stage 0-I according to Japanese General Rules for Pancreatic Cancer) and advanced stage (stage II-IVa) PDAC groups and diagnostic processes were also analyzed.
Results: Twenty-four of 299 patients (8%) had early stage PDACs (11 stage 0 and 13 stage I). The proportions of the early stage PDACs during the first and second half decade were 6% (4 / 64) and 9% (20 / 235), respectively (P = 0.80). The survival time of the patients with early stage PDACs was significantly longer than that with advanced stage PDACs (P < 0.01). Univariate and multivariate analyses revealed that the presence of intraductal papillary mucinous neoplasm (IPMN) (P < 0.01), history of pancreatitis (P < 0.01), and history of extrapancreatic malignancies (P = 0.01) were independent predictive factors for the diagnosis of early stage PDACs. Sensitivities of computed tomography (CT), magnetic resonance imaging / cholangiopancreatography (MRI / MRCP), endoscopic ultrasonography (EUS), and cytological examination during endoscopic retrograde pancreatography (ERP cytology) to diagnose early stage PDACs were 29%, 35%, 33%, and 65%, respectively. In early stage group, 10 of 24 patients had IPMN and 9 had a history of pancreatitis. ERP cytology could serve the preoperative diagnosis of PDAC in 13 of 24 patients, and 9 PDACs (38%) were diagnosed only by ERP cytology.
Conclusion: Detailed examination using ERP cytology in patients with IPMN or pancreatitis may contribute to the early diagnosis of PDAC.
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