Pancreatic cancer natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with complete remission extremely rare.[1]
Prognosis
- The primary factors that influence prognosis are:
- Whether the tumor is localized and can be completely resected
- Whether the tumor has spread to lymph nodes or elsewhere
- Staging and TNM (tumour, lymph node, metastasis) classification related to incidence, treatment, and prognosis: [2]
| Staging and TNM Classification related to Incidence, Treatment, and Prognosis | ||||
|---|---|---|---|---|
| Stage | TNM Classification | Clinical Classification | Incidence at diagnosis (%) | 5-year survival rate (%) |
| 0 | Tis, N0, M0 | Resectable | 7.5 | 15.2 |
| IA | T1, N0, M0 | — | — | — |
| IB | T2, N0, M0 | — | — | — |
| IIA | T3, N0, M0 | — | — | — |
| IIB | T1-3, N1, M0 | Locally advanced | 29.3 | 6.3 |
| III | T4, any N, M0 | — | — | — |
| IV | Any T, any N, M1 | Metastatic | 47.2 | 1.6 |
5-Year Survival
- For patients with localized disease and small cancers (<2 cm) with no lymph node metastases and no extension beyond the capsule of the pancreas, complete surgical resection is associated with an actuarial 5-year survival rate of 18% to 24%.
- Between 2007 and 2010, the 5-year relative survival of patients with pancreatic cancer was 7.2%.[3]
- When stratified by age, the 5-year relative survival of patients with pancreatic cancer was 10% and 4.6% for patients <65 and ≥ 65 years of age respectively.[3]
- The survival of patients with pancreatic cancer varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of pancreatic cancer:[3]
| Stage | 5-year relative survival (%), (2004-2010) |
| All stages | 6.7% |
| Localized | 25.8% |
| Regional | 9.9% |
| Distant | 2.3% |
| Unstaged | 4.4% |
Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1988 and 2010 of pancreatic cancer by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[3]
References
- ↑ Ghaneh P, Costello E, Neoptolemos JP (2007). "Biology and management of pancreatic cancer". Gut. 56 (8): 1134–52. doi:10.1136/gut.2006.103333. PMID 17625148.
- ↑ Bond-Smith G, Banga N, Hammond TM, Imber CJ (2012). "Pancreatic adenocarcinoma". BMJ. 344: e2476. doi:10.1136/bmj.e2476. PMID 22592847.
- ↑ 3.0 3.1 3.2 3.3 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.