Prognosis of human pancreatic adenocarcinoma: Review of clinical and histopathological variables and possible uses of new molecular methods

Cancer of the exocrine pancreas is a disease of considerable importance in gastroenterology. In Western countries it is the fourth commonest cause of death from cancer after those of lung, colorectal, and breast. The incidenc e of pancreatic carcinoma has increased in Northern Europe and North Americ a during recent decades and contrary to for example, lung, gastric and oeso phageal carcinoma, its incidence is still increasing the annual incidence i s about 8-10/100 000 population. The causes of its increased incidence are unknown, as is the aetiology of the disease itself. Pancreatic cancer gener ally grows without symptoms until late in its natural history and there are therefore many discouraging unresolved problems in management. However, so me progress has been made in understanding the molecular basis of pancreati c carcinogenesis. Recent molecular pathological studies have described muta tion or overexpression of important oncogenes such as K-ras and bcl-2 and d eletions of tumour suppression genes such p53, DPC4, CDKN2, and the Rb gene . The present prognosis of pancreatic cancer is, however, controversial, an d as these new markers may have the potential for improving our ability to predict its course, we have reviewed current knowledge, and concentrated on the classic and the recently-introduced factors in the prediction of its p rognosis.