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Annals of Surgical Oncology

, 12:145 | Cite as

The Prognostic Effect of Clinical Staging in Pancreatic Adenocarcinoma

  • Alessio G. Morganti
  • M. Gabriella Brizi
  • Gabriella Macchia
  • Giuseppina Sallustio
  • Guido Costamagna
  • Sergio Alfieri
  • Gian Carlo Mattiucci
  • Vincenzo Valentini
  • Luigi Natale
  • Francesco Deodato
  • Massimiliano Mutignani
  • G. Battista Doglietto
  • Numa Cellini
Article

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.

Keywords

Pancreatic neoplasms Imaging Staging Prognostic factors Surgery Radiotherapy 

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Copyright information

© The Society of Surgical Oncology, Inc. 2005

Authors and Affiliations

  • Alessio G. Morganti
    • 1
  • M. Gabriella Brizi
    • 2
  • Gabriella Macchia
    • 1
  • Giuseppina Sallustio
    • 3
  • Guido Costamagna
    • 4
  • Sergio Alfieri
    • 5
  • Gian Carlo Mattiucci
    • 6
  • Vincenzo Valentini
    • 6
  • Luigi Natale
    • 2
  • Francesco Deodato
    • 1
  • Massimiliano Mutignani
    • 4
  • G. Battista Doglietto
    • 5
  • Numa Cellini
    • 6
  1. 1.Department of RadiotherapyCentro di Ricerca e Formazione ad Alta Tecnologia nelleScienze Biomediche, Universitá Cattolica del S. CuoreContrada TappinoItaly
  2. 2.Department of RadiologyUniversità Cattolica del S. CuoreRomeItaly
  3. 3. Department of Radiology, Centro di Ricerca e Formazione ad Alta Tecnologia nelle ScienzeBiomedicheUniversità Cattolica del S. CuoreContrada TappinoItaly
  4. 4.Department of Digestive EndoscopyUniversità Cattolica del S. CoureRomeItaly
  5. 5.Department of SurgeryUniversità Cattolica del S. CuoreRomeItaly
  6. 6.Department of RadiotherapyUniversitá Cattolica del S. CuoreRomeItaly

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