Prognostic parameters determining survival in pancreatic carcinoma and, inparticular, after palliative treatment

Prognosis and outcome of patients with pancreatic carcinoma is poor. The ai m of the study was to investigate (I)which factors of medical history and c linical status as well as which laboratory parameters determine survival in pancreatic carcinoma and (2) whether specific data can be used as prognost ic parameters or for early diagnosis of pancreatic carcinoma. In total, 287 patients with pancreatic carcinoma were enrolled in the study. In 193 subj ects, only palliative treatment was possible. Survival was assessed using u nivariate survival probability curves by Kaplan-Meier. Comparison of patien t groups with regard to survival was achieved using the log-rank test. Mult ivariate analysis was carried out using the Cox regression model. Overall, 22 factors, showing a significant impact on survival in pancreatic carcinom a were found, e.g., tumor-associated factors such as (I)tumor stage accordi ng to the UICC classification including TNM-based staging, grading, tumor s ite, and vascular infiltration; (2) preoperative habits and signs and sympt oms (physical condition, pain, loss of appetite, ethanol consumption); (3) change of laboratory parameters (CA 19-9, bilirubin, prothrombin time, urea , C-reactive protein), and (4) type of intervention (surgical approach, R0/ 1/2 resection). Using multivariate analysis, seven factors (UICC tumor sta ge and site, surgical intervention including number of resected lymph nodes , chemotherapy, occurence of a carcinoma in relatives, preoperative physica l condition, night sweat) were determined. In the 193 patients with palliat ive treatment, only ten factors (among them UICC tumor stage including the presence of metastases; data from the medical history such as physical cond ition, loss of appetite, and carcinoma in relatives, and laboratory paramet ers including prothrombin time, protein content, and aspartate aminotransfe rase levels) were found to be important. Chemotherapy had the strongest imp act on survival which was confirmed by multivariate analysis, followed by t umor stage (UICC) and preoperative appetite. Besides tumor-associated deter minants, data from the medical history, and pathological laboratory paramet ers, the prognosis in pancreatic carcinoma is considerably determined by th e treatment such as interventional and/or using antineoplastic agents. Copy right (C) 2001 S. Karger AG, Basel.