gms | German Medical Science

Introduction: In early pancreatic cancer, the prognosis is unchangeably dismal specifically in patients with R1 resection or other local risk factors. However, an improvement of prognosis may be achieved for some patients through interdisciplinary treatment concepts.

Methods and Materials: Between 4/1999 and 4/2005, 105 patients undergoing resection of an adenocarcinoma of the pancreas received a postoperative chemoradiation using gemcitabine. They had histologically proven local risk factors (R1 resection and/or pN1 and/or L1).

The goal of this analysis was to evaluate the prognostic importance of the local macroscopic and microscopic tumor expansion.

Results: Median time to progression was 15.4 months (range 12.3_18.4) and the median actuarial overall survival of the patients was 25.3 months (range 18.8_31.7). It could be shown that patients with primary lymph node metastases have a significantly worse survival than patients in stage pN0 (pN0 –median not achieved, 5-year survival 54%, pN1 – median 22.4 months, 5-year survival 12%, p=0.003). Also tumor size turned out to have a significant impact on prognosis (TU</= 2 cm vs. > 2 cm; median 59.8 vs. 22.8 months, p=0.024). Neither the resection status (R0 vs R1) nor tumor localization (head vs corpus vs tail) were independent determinants of survival.

Conclusion: In high risk patients undergoing resection of localized pancreatic cancer, chemoradiotherapy, eliminated the prognostic importance of the resection status (R1 vs R0), while lymph node involvement and tumor size were observed as the only prognostic factors of survival.