Skip to main content
SpringerLink
Log in

The Prognostic Effect of Clinical Staging in Pancreatic Adenocarcinoma

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The importance of pancreatic cancer staging is uncertain. The aim of this report was to evaluate the accuracy of combined standard imaging techniques in predicting the pathologic stage and to evaluate the prognostic effect of clinical staging to identify patient groups in which laparoscopy and laparotomy could be beneficial.

Methods

Fifty-four patients were included in this analysis. The techniques used for clinical staging were endoscopic retrograde cholangiopancreatography, abdominal computed tomographic scan, and ultrasonography. All patients underwent both clinical and surgical/pathologic staging. A comparison was performed between presurgical stage and surgical/pathologic stage. The prognostic effect of different factors on survival was evaluated with both univariate (log-rank) and multivariate (Cox) analysis.

Results

Sensitivity and specificity for vascular involvement were 73.9% and 96.3%, respectively. Sensitivity and specificity for nodal involvement were 63.6% and 95.4%, respectively. A total of 33.3% of patients showed a higher than expected pathologic stage, and 3.7% showed a lower than expected pathologic stage, by comparing clinical and pathologic evaluation. A highly significant correlation was observed between clinical T stage (P = .0067) and tumor diameter (P = .0037) and patient survival. Maximal prognostic differentiation was observed by dividing patients into two groups based on imaging results: group A (favorable prognosis) and group B (unfavorable prognosis). The median survival was 25.1 and 8.0 months for group A and B, respectively. Five-year survival was 20.1% and 0%, respectively (multivariate analysis: P = .0007).

Conclusions

Integrated standard imaging studies achieved reasonable diagnostic accuracy in our analysis. A single classification based on clinical stage and tumor diameter evaluated by imaging predicts prognosis in patients with pancreatic carcinoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. RE Jimenez AL Warshaw DW Rattner CG Willett D McGrath C Fernandez-del Castillo (2000) ArticleTitleImpact of laparoscopic staging in the treatment of pancreatic cancer Arch Surg 135 409–14 Occurrence Handle1:STN:280:DC%2BD3c3ivFWqsA%3D%3D Occurrence Handle10768705

    CAS  PubMed  Google Scholar 

  2. PF Saldinger M Reilly K Reynolds et al. (2000) ArticleTitleIs CT angiography sufficient for prediction of resectability of periampullary neoplasms? J Gastrointest Surg 4 233–7 Occurrence Handle10.1016/S1091-255X(00)80071-2 Occurrence Handle1:STN:280:DC%2BD3czosFyjsw%3D%3D Occurrence Handle10769085

    Article  CAS  PubMed  Google Scholar 

  3. FR Spitz JL Abruzzese JE Lee et al. (1997) ArticleTitlePreoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas J Clin Oncol 15 928–37 Occurrence Handle1:STN:280:DyaK2s3htlynsw%3D%3D Occurrence Handle9060530

    CAS  PubMed  Google Scholar 

  4. HJ Wanebo AS Glicksmann MP Vezeridis et al. (2000) ArticleTitlePreoperative chemotherapy, radiotherapy, and surgical resection of locally advanced pancreatic cancer Arch Surg 135 81–7 Occurrence Handle10.1001/archsurg.135.1.81 Occurrence Handle1:STN:280:DC%2BD3c7gtVejug%3D%3D Occurrence Handle10636353

    Article  CAS  PubMed  Google Scholar 

  5. H Snady H Bruckner A Cooperman J Paradiso L Kiefer (2000) ArticleTitleSurvival advantage of combined chemoradiotherapy compared with resection as the initial treatment of patients with regional pancreatic carcinoma An outcomes trial Cancer 89 314–27 Occurrence Handle10.1002/1097-0142(20000715)89:2<314::AID-CNCR16>3.0.CO;2-V Occurrence Handle1:STN:280:DC%2BD3czptlSjtg%3D%3D Occurrence Handle10918161

    Article  CAS  PubMed  Google Scholar 

  6. AG Kamthan JC Morris J Dalton et al. (1997) ArticleTitleCombined modality therapy for stage II and stage III pancreatic carcinoma J Clin Oncol 15 2920–7 Occurrence Handle1:CAS:528:DyaK2sXls1Smurk%3D Occurrence Handle9256136

    CAS  PubMed  Google Scholar 

  7. R Delcore FJ Rodriguez J Forster AS Hermreck JH Thomas (1996) ArticleTitleSignificance of lymph node metastases in patients with pancreatic cancer undergoing curative resection Am J Surg 172 463–8 Occurrence Handle1:STN:280:DyaK2s%2FpvVSjtg%3D%3D Occurrence Handle8942545

    CAS  PubMed  Google Scholar 

  8. A Tannapfel C Wittekind G Hunefeld (1992) ArticleTitleDuctal adenocarcinoma of the pancreas. Histopathological features and prognosis Int J Pancreatol 12 145–52 Occurrence Handle1:STN:280:DyaK3s%2FpsVKmsA%3D%3D Occurrence Handle1460329

    CAS  PubMed  Google Scholar 

  9. AB Gorelick JM Scheiman AM Fendrick (1998) ArticleTitleIdentification of patients with resectable pancreatic cancer: at what stage are we? Am J Gastroenterol 93 1995–6 Occurrence Handle1:STN:280:DyaK1cvktlSktw%3D%3D Occurrence Handle9772077

    CAS  PubMed  Google Scholar 

  10. MJ Midwinter CJ Beveridge JB Wilsdon MK Bennett CJ Baudouin RM Charnley (1999) ArticleTitleCorrelation between spiral computed tomography, endoscopic ultrasonography and findings at operation in pancreatic and ampullary tumours Br J Surg 86 189–93 Occurrence Handle1:STN:280:DyaK1M7pvVyrtg%3D%3D Occurrence Handle10100785

    CAS  PubMed  Google Scholar 

  11. EK Fishman KM Horton BA Urban (2000) ArticleTitleMultidetector CT angiography in the evaluation of pancreatic carcinoma: preliminary observations J Comput Assist Tomogr 24 849–53 Occurrence Handle1:STN:280:DC%2BD3M%2FmsVCjtQ%3D%3D Occurrence Handle11105699

    CAS  PubMed  Google Scholar 

  12. WM Tierney IR Francis F Eckhauser G Elta TT Nostrant JM Scheiman (2001) ArticleTitleThe accuracy of EUS and helical CT in the assessment of vascular invasion by periampullary malignancy Gastrointest Endosc 53 182–8 Occurrence Handle1:STN:280:DC%2BD3MzjslyjsA%3D%3D Occurrence Handle11174289

    CAS  PubMed  Google Scholar 

  13. PC Freeny (2001) ArticleTitlePancreatic carcinoma: imaging update 2001 Dig Dis 19 37–46 Occurrence Handle10.1159/000050652 Occurrence Handle1:STN:280:DC%2BD3MzhtFOjtg%3D%3D Occurrence Handle11385250

    Article  CAS  PubMed  Google Scholar 

  14. HR Mertz P Sechopoulos D Delbeke SD Leach (2000) ArticleTitleEUS, PET, and CT scanning for evaluation of pancreatic adenocarcinoma Gastrointest Endosc 52 367–71 Occurrence Handle10.1067/mge.2000.107727 Occurrence Handle1:STN:280:DC%2BD3cvpsFCjtg%3D%3D Occurrence Handle10968852

    Article  CAS  PubMed  Google Scholar 

  15. CG Diederichs L Staib J Vogel et al. (2000) ArticleTitleValues and limitations of 18F-fluorodeoxyglucose-positron-emission tomography with preoperative evaluation of patients with pancreatic masses Pancreas 20 109–16 Occurrence Handle10.1097/00006676-200003000-00001 Occurrence Handle1:STN:280:DC%2BD3c7ntVWqtQ%3D%3D Occurrence Handle10707924

    Article  CAS  PubMed  Google Scholar 

  16. EA Minnard KC Conlon A Hoos EC Dougherty LE Hann MF Brennan (1998) ArticleTitleLaparoscopic ultrasound enhances standard laparoscopy in the staging of pancreatic cancer Ann Surg 228 182–7 Occurrence Handle1:STN:280:DyaK1czns1CjtQ%3D%3D Occurrence Handle9712562

    CAS  PubMed  Google Scholar 

  17. CL Fernandez-del Castillo AL Warshaw (1998) ArticleTitlePancreatic cancer. Laparoscopic staging and peritoneal cytology Surg Oncol Clin North Am 7 135–42 Occurrence Handle1:STN:280:DyaK1c7gvVSmuw%3D%3D

    CAS  Google Scholar 

  18. TC Bottger J Boddin C Duber A Heintz R Kuchle T Junginger (1998) ArticleTitleDiagnosing and staging of pancreatic carcinoma—what is necessary? Oncology 55 122–9 Occurrence Handle1:STN:280:DyaK1c7jvFWksg%3D%3D Occurrence Handle9499186

    CAS  PubMed  Google Scholar 

  19. P Marano MG Brizi N Cellini et al. (1993) ArticleTitleDiagnostic and therapeutic integration in ductal carcinoma of the head of the pancreas. Preliminary note Radiol Med 85 615–24 Occurrence Handle1:STN:280:DyaK3szhsl2ltw%3D%3D Occurrence Handle8392216

    CAS  PubMed  Google Scholar 

  20. P Montemaggi R Dobelbower SuffixJr F Crucitti et al. (1991) ArticleTitleInterstitial brachytherapy for pancreatic cancer: report of seven cases treated with 125-I and a review of the literature Int J Radiat Oncol Biol Phys 21 451–7 Occurrence Handle1:STN:280:DyaK3M3osF2nuw%3D%3D Occurrence Handle2061121

    CAS  PubMed  Google Scholar 

  21. F Crucitti GB Doglietto D Frontera et al. (1998) ArticleTitleIntegrated radiosurgical treatment of resectable pancreatic head carcinoma Pancreas 16 31–9 Occurrence Handle1:STN:280:DyaK1c%2Fpslelsg%3D%3D Occurrence Handle9436860

    CAS  PubMed  Google Scholar 

  22. AG Morganti V Valentini G Macchia et al. (2004) ArticleTitle5-FU-based chemoradiation in unresectable pancreatic carcinoma: a phase II dose escalation study Int J Radiat Oncol Biol Phys 54 1454–60

    Google Scholar 

  23. Exocrine pancreas. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual. 5th ed. Lippincott-Raven, Philadelphia, 1997; pp 121–6.

  24. FL Kaplan P Meier (1958) ArticleTitleNonparametric estimation from incomplete observations Am J Stat Assoc 53 457–81

    Google Scholar 

  25. R Peto J Peto (1972) ArticleTitleAsymptotically efficient rank invariant procedures J R Stat Soc 135 185–207 Occurrence Handle10.2307/2344317

    Article  Google Scholar 

  26. DR Cox (1972) ArticleTitleRegression model and life tables J R Stat Soc B 34 187–220

    Google Scholar 

  27. MB Sheridan J Ward JA Guthrie et al. (1999) ArticleTitleDynamic contrast-enhanced MR imaging and dual-phase helical CT in the preoperative assessment of suspected pancreatic cancer: a comparison study with receiver operating characteristics analysis AJR Am J Roentgenol 173 583–9 Occurrence Handle1:STN:280:DyaK1MzpslCrtw%3D%3D Occurrence Handle10470884

    CAS  PubMed  Google Scholar 

  28. A Tomazic V Pegan (2000) ArticleTitlePreoperative staging of periampullar cancer with US, CT, EUS and Ca19-9 Hepatogastroenterology 47 1135–7 Occurrence Handle1:STN:280:DC%2BD3cvmslGisQ%3D%3D Occurrence Handle11020897

    CAS  PubMed  Google Scholar 

  29. A Riker SK Libutti DL Bartlett (1997) ArticleTitleAdvances in the early detection, diagnosis, and staging of pancreatic cancer Surg Oncol 6 157–69 Occurrence Handle1:STN:280:DyaK1c3js1Wlug%3D%3D Occurrence Handle9576631

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiotherapy, Centro di Ricerca e Formazione ad Alta Tecnologia nelleScienze Biomediche, Universitá Cattolica del S. Cuore, Contrada Tappino, 86100, Campobasso, Italy

    Alessio G. Morganti MD, Gabriella Macchia MD & Francesco Deodato MD

  2. Department of Radiology, Università Cattolica del S. Cuore, Largo Gemelli 8, 00168, Rome, Italy

    M. Gabriella Brizi MD & Luigi Natale MD

  3. Department of Radiology, Centro di Ricerca e Formazione ad Alta Tecnologia nelle ScienzeBiomediche, Università Cattolica del S. Cuore, Contrada Tappino, 86100, Campobasso, Italy

    Giuseppina Sallustio MD

  4. Department of Digestive Endoscopy, Università Cattolica del S. Coure, Largo Gemelli 8, 00168, Rome, Italy

    Guido Costamagna MD & Massimiliano Mutignani MD

  5. Department of Surgery, Università Cattolica del S. Cuore, Largo Gemelli 8, Rome, 00168, Italy

    Sergio Alfieri MD & G. Battista Doglietto MD

  6. Department of Radiotherapy, Universitá Cattolica del S. Cuore, Largo Gemelli 8, Rome, 00168, Italy

    Gian Carlo Mattiucci MD, Vincenzo Valentini MD & Numa Cellini MD

Authors
  1. Alessio G. Morganti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Gabriella Brizi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriella Macchia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giuseppina Sallustio MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guido Costamagna MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sergio Alfieri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gian Carlo Mattiucci MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Vincenzo Valentini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Luigi Natale MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Francesco Deodato MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Massimiliano Mutignani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. G. Battista Doglietto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Numa Cellini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gabriella Macchia MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morganti, A.G., Brizi, M.G., Macchia, G. et al. The Prognostic Effect of Clinical Staging in Pancreatic Adenocarcinoma. Ann Surg Oncol 12, 145–151 (2005). https://doi.org/10.1245/ASO.2005.02.021

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2005.02.021

Keywords

Search

Navigation