Survival and prognostic factors of unresectable pancreatic cancer

GOALS: The aim of this study was to evaluate the prognostic significance of clinical and laboratory variables, and to investigate survival benefits for different treatment modalities in unresectable pancreatic cancer. BACKGROUND: The majority of pancreatic cancers are found to be unresectable. Therefore, estimations of prognosis and decisions of treatment modalities are important in optimizing the various aspects of care. STUDY: Three hundred and forty unresectable locally advanced, or metastatic pancreatic cancer patients were enrolled from January 1998 to January 2005 at the Seoul National University Hospital. RESULTS: One hundred and five patients received chemotherapy only and 59 patients received concurrent chemoradiotherapy (CCRT). Age, performance status, tumor location, initial CA 19-9 level, American Joint Committee on Cancer stage, and treatment modality (supportive care only, chemotherapy, vs. CCRT) were found to have prognostic significance for overall survival (OS) by univariate analysis, whereas initial CA 19-9 level, stage, and treatment modality were identified as independent prognostic factors by multivariate analysis. In subgroup analysis, stage III patients treated by CCRT (median OS, 10.4 mo) or chemotherapy alone (11.3 mo) showed survival benefit over supportive care (6.4 mo), and stage IV patients treated by chemotherapy alone (6.4 mo) showed survival benefit over supportive care (3.1 mo). CONCLUSIONS: Initial CA 19-9, American Joint Committee on Cancer stage, and treatment modality were independent prognostic factors of OS, and the patients who received chemotherapy or CCRT showed better survival than those who received supportive care only.