Système gastro-intestinal et digestif

Abstrait

Prognostic Factors in Pancreatic Cancer: The Role of Perineural, Vascular and Lymphatic Invasion and of Ca19-9

Berardi R, Mandolesi A, Pellei C, Maccaroni E, Onofri A, Lucarelli A, Biagetti S, Alfonsi S, Caramanti M, Savini A, Bearzi I and Cascinu S

Objective: The aim of our analysis was to investigate the impact of perineural, vascular and lymphatic invasion and of CA19-9 on survival in patients with locally advanced and metastatic pancreatic cancer, with the objective to serve as a tool for a more accurate and rational treatment selection. Methods: We analyzed 181 consecutive patients with locally advanced unresectable pancreatic cancer and metastatic pancreatic cancer who received chemotherapy at our Institution between 2000 and 2010. Results: At univariate analysis CA19-9 represented a prognostic factor (median overall survival if CA19-9 ≤ 37 U/ml vs. >37 U/ml was 18.49 vs. 9.21 months, respectively, p=0,0004), while surprisingly the presence of vascular, lymphatic and perineural invasion was found to be a favorable prognostic factor (median overall survival in patients with invasion vs. without invasion was 27.5 vs. 9.6 months, respectively, p=0.0002).At multivariate analysis the presence of invasion was found to be an independent favorable prognostic factor, while the high level of CA19-9 resulted an independent unfavorable prognostic factor. Conclusion: High values of CA19-9 at the beginning of the first-line chemotherapy represent an independent prognostic factor, therefore it should be taken into consideration to select the treatment. Surprisingly the presence of invasion appeared as an independent favorable prognostic factor in locally advanced and metastatic pancreatic cancer and this result may impact therapy decisions and stratification of future clinical trials.