Predictors and Diagnostic Strategies for Early-Stage Pancreatic Ductal Adenocarcinoma: A Retrospective Study. Issue 7 (October 2015)

• Record Type: Journal Article
• Authors: Kimura, Hideyo; Ohtsuka, Takao; Matsunaga, Taketo; Watanabe, Yusuke; Tamura, Koji; Ideno, Noboru; Aso, Teppei; Miyazaki, Tetsuyuki; Osoegawa, Takashi; Aishima, Shinichi; Miyasaka, Yoshihiro; Ueda, Junji; Ushijima, Yasuhiro; Igarashi, Hisato; Ito, Tetsuhide; Takahata, Shunichi; Oda, Yoshinao; Mizumoto, Kazuhiro; Tanaka, Masao
• Is Part Of: Pancreas. Volume 44:Issue 7(2015)
• Publication Date: 2015-10
• Subjects: pancreatic ductal adenocarcinoma -- early-stage pancreatic cancer -- endoscopic retrograde pancreatography (ERP); Pancreas -- Diseases -- Periodicals; Pancreas -- Periodicals; Neuroendocrine tumors -- Periodicals; 616.37005
• DOI: 10.1097/MPA.0000000000000393
• Languages: English
• ISSNs: 0885-3177

Abstract

Abstract : Objectives: As a strategy to diagnose early-stage pancreatic ductal adenocarcinoma (PDAC) is urgently needed, we aimed to clarify characteristics of early-stage PDAC. Methods: We retrospectively reviewed medical records of 299 consecutive patients who underwent R0 or R1 surgical resection for PDAC between 1994 and 2013 and compared clinical characteristics between patients with early-stage (stages 0–I by Japanese General Rules for Pancreatic Cancer) and advanced-stage (stages II–IV) disease. Diagnostic processes were also analyzed. Results: Twenty-four patients (8%) had early-stage PDAC (stage 0: 11; stage I: 13). Univariate and multivariate analyses showed that presence or history of intraductal papillary mucinous neoplasm ( P < 0.01), history of pancreatitis ( P < 0.01), and presence or history of extrapancreatic malignancies ( P = 0.01) independently predicted detection of early-stage PDAC. Cytological examination during endoscopic retrograde pancreatography cytology was ∼65% sensitive in preoperative diagnosis of early-stage PDAC, whereas other imaging modalities were only 29% to 38% sensitive; 9 of 24 early-stage PDACs were diagnosed by endoscopic retrograde pancreatography cytology alone. Conclusions: Endoscopic retrograde pancreatography cytology for patients with intraductal papillary mucinous neoplasm or pancreatitis may help diagnose early-stage PDAC. Surveillance of extrapancreatic malignancies might also provide opportunities to detect early-stage PDAC as a second malignancy.