gms | German Medical Science

Background: Nuclear DNA content and pathology are considered to be prognostically relevant to several solid tumors, but controversial findings have emerged from pancreatic carcinoma.

Methods: During the period of 4 years (8/99 –12/ 03) we enrolled a total of 64 patients with histologically proven ductal adenocarcinoma of the pancreas in a prospective study. DNA ploidy was assessed by image cytometry in cytological specimens obtained from ERCP by aspiration and brush cytology.All 64 patients were followed up till death(n=48) or in case of survival(n=16) a mean follow-up period was 12 months.

Results: Median survival rate of all patients affected from pancreatic carcinoma was 13 months. At time of diagnosis, 5% (n=3) of patients presented pT2 carcinoma, 84% (n=54) revealed pT3 tumors und 11% (n=7) showed pT4 tumors. Patients presenting the same tumor stage revealed different ploidy patterns associated with varying surival times Curative resection (RO) of the pancreatic carcinoma could be accomplished in 42% of the cohort while 14% of patients received incomplete resection with remaining tumor cells (R1/2). In addition, further 44% (n=28) of patients were unresectable at time of diagnosis. Histologic grading revealed most frequently poorly differentiated pancreatic carcinoma cells (G3, 48%) while less patients showed moderatly differentiated cacrinoma (G2, 47%) or good differentiated neoplasia (G1, 5%). DNA ploidy was compared to tumor stage (pT), histologic differention (pG) with regard to the clinical course and survival. DNA ploidy was the only significant predictor of survival shown by multivariate analysis.10 out of 17 patients affected from pancreatic carcinoma with diploid or polyploid DNA pattern survived tumor free during the follow up period .In contrast, 44 of 47 patients with aneuploid pancreatic carcinoma experienced tumor recurrence/persitance .The difference of suvival rates between patients with aneuploid versus diploid and polyploid carcinoma was highly significant (p<0,001).

Conclusions: Patients with pancreatic adenocarcinoma will survive longer if their cancer is diploid or tetraploid and will have a very poor prognosis if afflicted with DNA aneuploid cancer.The predictive value of DNA ploidy is present in patients with respectable or unresectable tumor stage.The results maybe helpful for predicting life expectancy, determining treatment strategies and designing future clinical trials.