Evaluation Of Demographic And Clinicopathological Characteristics Of Panreatic Adenocarcinoma Patients

INTRODUCTION: In patients with pancreatic cancer twenty-six percent are locally advanced, 52% are metastatic and only 20-15% are surgically removable at the time of diagnosis (1). One-year overall survival rate of pancreatic cancer is 26% while 5 year overall survival rate is only 6% (2) The aim of this study is to analyze the clinicopathological features of the pancreatic adenocarcinoma patients who admitted to the Ankara Oncology Training and Research hospital.
METHODS: Total 193 pancreatic adenocarcinoma patients, including 72 women and 121 men, who were followed in Ankara Oncology Training and Research Hospital between dates 2007-2011, were evaluated retrospectively.
RESULTS: Twenty-six of the patients (13,5%) had undergone curative resection, 54 patients (28%) with locally advanced disease were unresectable, while 113 patients (58,5%) had metastatic disease. For the entire group (n=193), median survival time was 6 months. Older age (more than median “61”), low performance status (ECOG≥3), weight loss or abdominal pain on admission, high grade tumor, locally advanced or metastatic disease, metastasis other than peritonea or liver, multiple metastases at the time of diagnosis were the parameters which significantly affect survival negatively. After excluding the curatively operated patients, high levels of Ca 19-9 (higher than median value: 616) were associated with poor survival in patients with locally advanced or metastatic disease (p=0,021). Chemotherapy was significantly superior to best supportive care in the metastatic disease. Median overall survival in patients treated with chemotherapy versus best supportive care was 7 months (4,7 to 9,3) and 1 month (0,2 to 1,7) respectively (p<0,0001). There was no significant difference in overall survival with chemotherapy versus best supportive care in locally advanced unresectable group.
DISCUSSION AND CONCLUSION: As a result of demographic and clinical examination of patients, we generally reached similar conclusions with previous studies. Low median age of the disease may be associated with an earlier age of onset of smoking in Turkey. It would be wise to consider performance status and stage of the disease rather than the age of the patient while making treatment decisions.

Pankreas Adenokarsinomlu Hastalarýn Demografik Ve Klinikopatolojik Özelliklerinin Deðerlendirmesi

GÝRÝÞ ve AMAÇ: Pankreas kanserleri hastalarýnýn taný anýnda sadece %15-20’si cerrahi olarak çýkarýlabilir aþamada olup %52’sinde yaygýn hastalýk %26’sýnda bölgesel yayýlým mevcuttur (1). Pankreas kanserinin bir yýllýk genel sað kalým oraný %26, beþ yýllýk ise % 6’dýr (2). Bu çalýþmanýn amacý Türkiye’de merkezi bir bölgede bulunan ve referans merkez olarak kabul edilen Ankara Onkoloji Eðitim Araþtýrma Hastanesi’ne baþvuran pankreas adenokanserli hastalarýn klinikopatolojik özelliklerinin incelenmesidir.
YÖNTEM ve GEREÇLER: Çalýþma için Ankara Onkoloji Eðitim ve Araþtýrma Hastanesi’nde 2007-2011 tarihleri arasýnda izlenmiþ 121 erkek ve 72 kadýndan oluþan toplam 193 pankreas adenokanseri hastasý retrospektif olarak tarandý.
BULGULAR: Hastalarýn 26’sýna (%13,5) küratif rezeksiyon uygulanmýþtý, 54 hasta (%28) lokal ileri çýkarýlamaz, 113 hasta ise (%58,5) metastatik evredeydi. Tüm grup için (n=193) ortanca sað kalým süresi 6 ay olarak bulundu. Yaþýn, ortanca yaþ olan 61 den büyük olmasý, ECOG performans durumunun 3 ve üzerinde deðer olmasý, baþlangýçta kilo kaybý olmasý, baþlangýçta karýn aðrýsý olmasý, tümör gradýnýn yüksek olmasý, tümörün lokal ileri veya metastatik olmasý, baþlangýç metastaz bölgesinin periton veya karaciðer dýþý olmasý, baþlangýçta çoklu metastaza sahip olunmasý sað kalýma anlamlý olumsuz yönde etkilemekteydi. Küratif opere edilen hastalar dýþlanarak çýkarýlamaz ve metastatik hastalar için bakýlan CA19-9 deðerinin ortanca deðer olan 616’nýn üzerinde olmasý kötü sað kalým ile iliþkili idi (p=0,021). Metastatik aþamada kemoterapi almýþ olmak en iyi destek tedavisine bariz olarak üstündü. Ortanca sað kalým kemoterapi almayan kol için 1 ay (0,2-1,7) iken almýþ olan kolda 7 (4,7-9,3) ay idi (p<0,0001). Lokal ileri çýkarýlamaz grupta ise bu fark gösterilemedi.
TARTIÞMA ve SONUÇ: Hastalarýn klinik ve demografik incelenmesi neticesinde daha önceden yapýlmýþ çalýþmalarla genellikle benzer sonuçlara ulaþýlmýþtýr. Hastalardaki ortanca yaþýn dünya ortancasýna göre düþük olmasý, Türkiye’de sigaraya baþlama yaþýnýn daha erken olmasý ile iliþkili olabileceðini akla getirmektedir. Tedavi kararý verirken yaþ durumundan çok performans durumuna ve evresine göre karar vermek akýllýca olacaktýr.