[New aspects of pancreatic carcinoma (author's transl)]

Characteristics of pancreatic carcinoma in the elderly

CONCLUSION

Lymphogenous as well as hematogenous metastases were significantly less frequent in the elderly group of patients, although local invasion was comparable. Survival was comparable between both groups although palliative therapy alone was significantly more frequent in the elderly.

BACKGROUND

The relative and absolute numbers of elderly patients continue to increase, as does the incidence of pancreatic carcinoma. To determine the optimal therapy for elderly patients with pancreatic carcinoma, we examined their clinicopathological features.

METHODS

The clinical and histopathological features of pancreatic carcinoma in patients 70 yr of age or older (n = 89) were compared with those in patients aged 69 yr or less (n = 184).

RESULTS

A total of 273 patients showed histologically tubular adenocarcinomas and their major variants. The male:female ratio peaked at 1:0.3 in patients under 49 yr old but gradually decreased to 1:1.2 in those aged over 80 yr. There were no significant differences between the two groups in the resectability, prognosis, location, or histology of the tumor. Hematogenous and lymphogenous metastases were detected at autopsy in 68 and 61% of patients old than 70, and in 82 and 80% of the younger group.

Evaluation of UICC TNM classification for pancreatic cancer. A study of 228 patients

CONCLUSION

A different stage grouping of TNM factors can improve the predictivity of the UICC TNM classification for pancreatic cancer. Nevertheless, the Japanese Pancreas Society (JPS) classification maintains a higher prognostic value.

BACKGROUND

The use of a reliable staging classification facilitates the evaluation of anticancer treatments and the correct management of patients. The aim of the present study was to evaluate the prognostic value of three modified UICC TNM classifications, obtained by different stage grouping of the UICC TNM factors, comparing their predictivity to the standard UICC and the JPS classifications.

METHODS

Clinical material consisted of 228 patients who underwent resection for pancreatic cancer. The reliability of the classifications was analyzed by the following methods: univariate analysis of stage survival curves; multivariate analysis of each classification after adjusting for grading and radicality; and correlation between the patients' distribution in the stages of each classification and in survival classes.

RESULTS

The following modified UICC classification allowed a better differentiation of stage II and III survival (P = 0.08) than standard UICC (P = 0.74): stage I: T1N0M0; stage II: T1N1M0/T2N0M0: stage III: T2N1M0/T3 any NM0; stage IV: M1. The JPS classification better discriminated between the different stages (P < 0.001). All classifications had an independent prognostic value by multivariate analysis. The correlation between stages and survival classes was higher for the JPS classification than either UICC TNM classification or the modified UICC classifications.

Staging of carcinoma of the pancreas and ampulla of Vater. Tumor (T), lymph node (N), and distant metastasis (M) as prognostic factors

Between 1984 and 1987, 472 Norwegian patients with histologically or cytologically verified carcinoma of the pancreas (N = 442) and ampulla of Vater (N = 30) were accrued and TNM staged according to UICC. The influence of the T, N, and M categories on long-term survival was evaluated. The T1a and T1b tumors of stage I pancreatic carcinoma had a comparable survival (p = 0.68-0.95). A higher T category (T1-T3) predicted a more dismal prognosis (p = 0.000). The T1 and T2 carcinomas of the ampulla of Vater had a comparable favorable prognosis, and the T3 and T4 tumors had a comparable unfavorable prognosis. The N1 vs N0 (p = 0.000-0.01) and M1 vs M0 categories (p = 0.00-0.003) predicted a more dismal prognosis for both pancreatic and ampullary carcinoma. By logistic regression analyses, pancreatic tumor extension into peripancreatic fat or nerves and invasion of ampullary carcinomas into duodenal wall, unfavorably influenced the N1 category (p = 0.000-0.04) and tumor diameter influenced the M1 category (p = 0.002-0.04) both for pancreatic and ampullary carcinoma. The T, N, and M categories all independently influenced survival of pancreatic carcinoma (p = 0.000-0.003). Only the N category (p = 0.01) influenced the prognosis of ampullary carcinomas.

Evaluating the role of photodynamic therapy in the management of pancreatic cancer

BACKGROUND AND OBJECTIVE

Cancer of the pancreas constitutes one of the major causes of cancer related death throughout the world. A 5-year survival rate of only 2% and a maximum of 20 months median survival in multi modality treatment studies dealing with the most favorable patients only, has been demonstrated. This review analyzes the principal treatments and available experimental data in view of a clinical application of photodynamic therapy (PDT) for the treatment of pancreatic cancer.

STUDY DESIGN/MATERIALS AND METHODS

On the basis of published results, we examined the palliation of pancreatic cancer by chemotherapy alone; radiation alone and multimodality schedules (radiation and chemotherapy). Radical tumor resection was examined as attempted curative treatment.

RESULTS

In reported therapeutic procedures, palliative or potentially curative, median survival was below 2 years. The GTSG reported survival time increases from 10.9 to 21.0 months when surgery is followed by adjuvant chemotherapy and radiation. This combination postoperatively does not increase mortality, but adds 30% morbidity. Photodynamic therapy has been demonstrated in preclinical studies to have a selective effect on malignant versus the normal pancreas.

CONCLUSION

PDT is highly effective in eliciting the destruction of experimental pancreatic tumors with the lack of significant effect on the normal pancreas. The poor prognosis for patients with this disease, especially those patients with advanced disease, warrants closer examination of PDT for the treatment of pancreatic cancer.

DNA ploidy and cell-cycle analysis in pancreatic and ampullary carcinoma: flow cytometric study of formalin-fixed paraffin-embedded tissue

The cellular DNA content of formalin-fixed, paraffin-embedded specimens from 47 ductal adenocarcinomas of the pancreas and 5 adenocarcinomas of the ampulla of Vater was analysed using flow cytometry. Ploidy and the fraction of cells in the S and G2M phases were determined and correlated with tumour stage and grade as well as patients' survival. Cell populations with aneuploid DNA content were observed in 15% of the tumours. The S + G2M fractions ranged between 1% and 10%. Compared to non-neoplastic tissue of the pancreas the S + G2M fraction was significantly higher in the carcinomas. Cox regression analysis revealed the S + G2M fraction as an independent prognostic factor (p less than 0.05). Ploidy was of no prognostic value for survival, but correlated weakly with tumour stage and tumour grade. All patients without lymph node metastases at time of surgery had diploid tumours. Aneuploidy was restricted to tumours in advanced stages and tended to be more frequent in high-grade tumours.

CA 19-9 and pancreatic adenocarcinoma

The diagnostic place value of CA 19-9, a tumor-associated antigen, was tested in 611 patients. This group of patients included 273 patients who suffered from a malignant disease (48 patients with pancreatic carcinomas and 225 patients with extrapancreatic malignant growths) and 338 patients with benign diseases (66 patients with chronic pancreatitis, 36 patients with acute pancreatitis, and 236 patients with general surgical diseases). In 93% of the patients with pancreatic carcinoma (media value, 528 U/ml), in 37% and 19% of the patients with carcinoma of the stomach and colorectal carcinomas (median value 8 U/ml), respectively, the CA 19-9 value was estimated as being above the normal limits of 6 to 37 U/ml. A sensitivity of 93% and a specificity of 85%, as well as a total accuracy of 82%, were established in pancreatic carcinoma during preoperative observation. The preoperatively raised CA 19-9 concentration in patients with pancreatic carcinomas dropped after curative resection of the carcinoma to within normal limits. However, a serum concentration of less than 37 U/ml was not recorded in any CA 19-9 estimation after a palliative surgical intervention, or in any case of inoperable carcinomas.

Exocrine pancreatic tumours and their histological classification. A study based on 167 autopsy and 97 surgical cases

Based on histopathological examination of 264 exocrine pancreatic tumours (167 autopsy and 97 surgical) from the files of the Institute of Pathology, University of Hamburg, over a 15-yr period (1966-1980), a histogenetic classification is proposed. In addition to the more common neoplasms this also includes rarer and more recently defined entities. Of the 264 tumours, 250 were of duct origin, 10 acinar and four of uncertain histogenesis. Ductal adenocarcinoma, subdivided into a well-differentiated and a poorly-differentiated type, was most frequent (81.1%), followed by its variants: pleomorphic giant cell carcinoma 5.3%, adenosquamous carcinoma 3.8%, and mucinous carcinoma 1.1%. All these had a poor prognosis. Serous cystadenoma (1.1%), mucinous cystic tumour (1.5%) and intraductal papilloma (0.8%), which were rare tumours and mostly apparent in surgical material, proved to be benign or of only latent malignancy. The group of tumours of acinar cell origin consisted of the solid and cystic tumour (2.7%) with favourable prognosis and the acinar cell carcinoma (1.1%). No pancreatoblastoma was observed. The pleomorphic carcinomas of the small cell type (1.5%) were classed as tumours of uncertain histogenesis.