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Long term survivors with metastatic pancreatic adenocarcinoma treated with gemcitabine: a retrospective analysis.

Goulart BH, Clark JW, Lauwers GY, Ryan DP, Grenon N, Muzikansky A, Zhu AX - J Hematol Oncol (2009)

Bottom Line: Baseline logarithm of CA19-9 and total bilirubin had a significant impact on OS (HR = 1.32 and 1.31, respectively).Only bilirubin and CA 19-9 levels were predictive of longer survival in this population.Further analysis of potential prognostic and predictive markers of response to treatment and survival are needed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Hematology/Oncology, Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. bhg@u.washington.edu

ABSTRACT

Background: Metastatic pancreatic adenocarcinoma has a short median overall survival (OS) of 5-6 months. However, a subgroup of patients survives more than 1 year. We analyzed the survival outcomes of this subgroup and evaluated clinical and pathological factors that might affect survival durations.

Methods: We identified 20 patients with metastatic or recurrent pancreatic adenocarcinoma who received single-agent gemcitabine and had an OS longer than 1 year. Baseline data available after the diagnosis of metastatic or recurrent disease was categorized as: 1) clinical/demographic data (age, gender, ECOG PS, number and location of metastatic sites); 2) Laboratory data (Hematocrit, hemoglobin, glucose, LDH, renal and liver function and CA19-9); 3) Pathologic data (margins, nodal status and grade); 4) Outcomes data (OS, Time to Treatment Failure (TTF), and 2 year-OS). The lowest CA19-9 levels during treatment with gemcitabine were also recorded. We performed a univariate analysis with OS as the outcome variable.

Results: Baseline logarithm of CA19-9 and total bilirubin had a significant impact on OS (HR = 1.32 and 1.31, respectively). Median OS and TTF on gemcitabine were 26.9 (95% CI = 18 to 32) and 11.5 (95% CI = 9.0 to 14.3) months, respectively. Two-year OS was 56.4%, with 7 patients alive at the time of analysis.

Conclusion: A subgroup of patients with metastatic pancreatic cancer has prolonged survival after treatment with gemcitabine. Only bilirubin and CA 19-9 levels were predictive of longer survival in this population. Further analysis of potential prognostic and predictive markers of response to treatment and survival are needed.

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Pathology from one Whipple specimen showed ductal adenocarcinoma, moderately differentiated. Irregularly shaped malignant glands infiltrated the desmoplastic stroma. Marked nuclear atypia was observed (Hematoxylin and Eosin 40× per High Power Field).
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Figure 2: Pathology from one Whipple specimen showed ductal adenocarcinoma, moderately differentiated. Irregularly shaped malignant glands infiltrated the desmoplastic stroma. Marked nuclear atypia was observed (Hematoxylin and Eosin 40× per High Power Field).

Mentions: Among the 6 resected cases, the size of the tumor was available in 5. Only one case measured less than 3 cm (2.5 cm) while the other 4 had a median size of 4.3 cm (range: 3.3 to 6.5 cm). Pathological margins and nodal status were assessed for the 6 surgical procedures. Of these, status of the resected margins was reported as negative in two cases (34%) and positive in four cases (66%). Five of the 6 resected patients had metastatic lymph nodes. The number of positive lymph nodes ranged from 1 to 7, with a median of 4. Excluding the cytologic material, the degree of differentiation was evaluated in 12 patients. One case (8%) showed a well-differentiated tumor, as opposed to five cases (42%) of moderately differentiated and 6 cases (50%) of poorly differentiated tumors. The subject with the well-differentiated tumor had a survival of 57.9 months, while subjects with poorly differentiated tumors showed a survival range from 12.4 to 24 months. An example of the cytology sample from FNA and a pathology specimen from Whipple surgery were shown in Figures 1 and 2, demonstrating the diagnosis of adenocarcinoma.


Long term survivors with metastatic pancreatic adenocarcinoma treated with gemcitabine: a retrospective analysis.

Goulart BH, Clark JW, Lauwers GY, Ryan DP, Grenon N, Muzikansky A, Zhu AX - J Hematol Oncol (2009)

Pathology from one Whipple specimen showed ductal adenocarcinoma, moderately differentiated. Irregularly shaped malignant glands infiltrated the desmoplastic stroma. Marked nuclear atypia was observed (Hematoxylin and Eosin 40× per High Power Field).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2663565&req=5

Figure 2: Pathology from one Whipple specimen showed ductal adenocarcinoma, moderately differentiated. Irregularly shaped malignant glands infiltrated the desmoplastic stroma. Marked nuclear atypia was observed (Hematoxylin and Eosin 40× per High Power Field).
Mentions: Among the 6 resected cases, the size of the tumor was available in 5. Only one case measured less than 3 cm (2.5 cm) while the other 4 had a median size of 4.3 cm (range: 3.3 to 6.5 cm). Pathological margins and nodal status were assessed for the 6 surgical procedures. Of these, status of the resected margins was reported as negative in two cases (34%) and positive in four cases (66%). Five of the 6 resected patients had metastatic lymph nodes. The number of positive lymph nodes ranged from 1 to 7, with a median of 4. Excluding the cytologic material, the degree of differentiation was evaluated in 12 patients. One case (8%) showed a well-differentiated tumor, as opposed to five cases (42%) of moderately differentiated and 6 cases (50%) of poorly differentiated tumors. The subject with the well-differentiated tumor had a survival of 57.9 months, while subjects with poorly differentiated tumors showed a survival range from 12.4 to 24 months. An example of the cytology sample from FNA and a pathology specimen from Whipple surgery were shown in Figures 1 and 2, demonstrating the diagnosis of adenocarcinoma.

Bottom Line: Baseline logarithm of CA19-9 and total bilirubin had a significant impact on OS (HR = 1.32 and 1.31, respectively).Only bilirubin and CA 19-9 levels were predictive of longer survival in this population.Further analysis of potential prognostic and predictive markers of response to treatment and survival are needed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Hematology/Oncology, Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. bhg@u.washington.edu

ABSTRACT

Background: Metastatic pancreatic adenocarcinoma has a short median overall survival (OS) of 5-6 months. However, a subgroup of patients survives more than 1 year. We analyzed the survival outcomes of this subgroup and evaluated clinical and pathological factors that might affect survival durations.

Methods: We identified 20 patients with metastatic or recurrent pancreatic adenocarcinoma who received single-agent gemcitabine and had an OS longer than 1 year. Baseline data available after the diagnosis of metastatic or recurrent disease was categorized as: 1) clinical/demographic data (age, gender, ECOG PS, number and location of metastatic sites); 2) Laboratory data (Hematocrit, hemoglobin, glucose, LDH, renal and liver function and CA19-9); 3) Pathologic data (margins, nodal status and grade); 4) Outcomes data (OS, Time to Treatment Failure (TTF), and 2 year-OS). The lowest CA19-9 levels during treatment with gemcitabine were also recorded. We performed a univariate analysis with OS as the outcome variable.

Results: Baseline logarithm of CA19-9 and total bilirubin had a significant impact on OS (HR = 1.32 and 1.31, respectively). Median OS and TTF on gemcitabine were 26.9 (95% CI = 18 to 32) and 11.5 (95% CI = 9.0 to 14.3) months, respectively. Two-year OS was 56.4%, with 7 patients alive at the time of analysis.

Conclusion: A subgroup of patients with metastatic pancreatic cancer has prolonged survival after treatment with gemcitabine. Only bilirubin and CA 19-9 levels were predictive of longer survival in this population. Further analysis of potential prognostic and predictive markers of response to treatment and survival are needed.

Show MeSH
Related in: MedlinePlus