Pancreatic adenocarcinoma in a young patient population - 12-Year experience at Memorial Sloan Kettering Cancer Center
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. Journal of Surgical Oncology
(Impact Factor: 3.24).
07/2009; 100(1):8-12. DOI: 10.1002/jso.21292
There is a dearth of data in a younger population of patients with pancreatic ductal adenocarcinoma (PAC) regarding epidemiology, genetics, prognosis, and outcome. This report examines a large cohort of patients with PAC <or=45 years of age evaluated at MSKCC over a 12-year period.
A retrospective analysis of patients referred to MSKCC with PAC identified from the institutional tumor registry, who were <or=45 years on the date of the diagnostic biopsy, between January 1995 and February 2008, was performed. Information reviewed included demographics, clinical and pathological staging, surgical management, therapy, date of relapse, death or last follow-up. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test.
One hundred thirty-six cases of PAC, age <or=45 years at diagnosis, were identified. Seventy-four (54%) females, 62 (46%) males. Age range: 24-45; 4, 38, and 94 patients in age groups 20-29, 30-39, 40-45 years, respectively. Fifty (37%) had a smoking history. Fourteen (10.3%) had a positive family history of PAC. Thirty-five (25.7%) underwent a curative resection for localized disease. Twenty-eight (20.1%) presented with locally advanced, inoperable disease. Sixty-eight (50%) presented as AJCC Stage IV. Twenty-three (37%) of those resected underwent adjuvant chemoradiation. Thirteen received adjuvant gemcitabine. The median overall survival for the entire cohort was 12.3 months (95% CI 10.2-14.0 months). The median overall survival for the patients with locally resectable disease was 41.8 months (95% CI 20.3-47 months). The median overall survival for the patients who presented with locally advanced, unresectable disease was 15.3 months (95% CI 12-19.3 months). The median overall survival for those who presented with metastatic disease was 7.2 months (95% CI 5.2-9.5 months).
This is the largest reported cohort of young patients with PAC <or=45 years of age. The data suggest that patients with stages I-II disease may have an improved prognosis, however the prognosis for stages III-IV patients appears to be similar to the typical (older) patient population with PAC.
Available from: Lukasz Liszka
- "These patients were diagnosed as EOPCs. The age cut-off value we implemented here (45 years) was selected based on the largest so far study of patients with EOPC performed by Dr. Duffy and associates at Memorial Sloan Kettering Cancer Center, New York . Patients with neoplasms of non-ductal origin [e.g., acinar cell carcinomas, neuroendocrine neoplasms (NENs), solid pseudopapillary neoplasms] were carefully excluded from the main study group. "
[Show abstract] [Hide abstract]
ABSTRACT: Early onset pancreatic cancer (EOPC) constitutes less than 5% of all newly diagnosed cases of pancreatic cancer (PC). Although histopathological characteristics of EOPC have been described, no detailed reports on precursor lesions of EOPC are available. In the present study, we aimed to describe histopathological picture of extratumoral parenchyma in 23 cases of EOPCs (definition based on the threshold value of 45 years of age) with particular emphasis on two types of precursor lesions of PC: pancreatic intraepithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasms (IPMNs). The types, grades, and densities of precursor lesions of PC were compared in patients with EOPCs, in young patients with neuroendocrine neoplasms (NENs), and in older (at the age of 46 or more) patients with PC. PanINs were found in 95.6% of cases of EOPCs. PanINs-3 were found in 39.1% of EOPC cases. Densities of all PanIN grades in EOPC cases were larger than in young patients with NENs. Density of PanINs-1A in EOPC cases was larger than in older patients with PC, but densities of PanINs of other grades were comparable. IPMN was found only in a single patient with EOPC but in 20% of older patients with PC. PanINs are the most prevalent precursor lesions of EOPC. IPMNs are rarely precursor lesions of EOPC. Relatively high density of low-grade PanINs-1 in extratumoral parenchyma of patients with EOPC may result from unknown multifocal genetic alterations in pancreatic tissue in patients with EOPCs.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 03/2011; 458(4):439-51. DOI:10.1007/s00428-011-1056-3 · 2.65 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Acute, persistent abdominal pain due to ruptured pancreatic carcinoma and perforated stomach is extremely rare during pregnancy.
We evaluated a woman at 34 weeks of gestation presenting with uterine contractions. Computed tomography scanning revealed a large retroperitoneal mass, and her blood carbohydrate antigen 19-9 level was elevated. Immediately after an emergency cesarean delivery, pancreatic cancer was detected, and pancreatoduodenectomy was performed. The patient underwent chemotherapy and remains disease-free at 2 years.
Delayed diagnosis and treatment are associated with high morbidity of both neonate and mother in cases of pancreatic cancer during pregnancy. Computed tomography scanning and carbohydrate antigen 19-9 levels are useful for diagnosis, after which radical surgery should be performed immediately in late pregnancy.
Obstetrics and Gynecology 08/2010; 116 Suppl 2(2):518-20. DOI:10.1097/AOG.0b013e3181de8995 · 5.18 Impact Factor
Available from: Bobby Tingstedt
[Show abstract] [Hide abstract]
ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) represents the fourth cause of death in cancer with a 5-year survival rate of less than 1-2%. Early onset pancreatic cancer (EOPC), i.e. patients below 50 years of age, is infrequently described. The present study aimed to determine the epidemiology, demographic incidence and prognosis of EOPC and to identify the characteristics that might distinguish EOPC.
576 consecutive patients with PDAC diagnosed from January 1993 to December 2008 at the University Hospital of Lund, Sweden. 65 different parameters were compared with a historic cohort of pancreatic cancer patients as well as with matched controls.
33 patients (5.7%) with PDAC were 50 years or younger. The overall survival was 170 days compared to 240 days for matched controls (p=n.s.). Patients with EOPC were diagnosed at a significantly more advanced stage, i.e. distant metastasis, (52%) as compared to matched controls (30%; p=0.04). EOPC-patients received more treatment than the compared PDAC-cohort.
EOPC constituted 5.7 % of all PDAC, presenting at an advanced stage with frequent metastases and poor survival. The role of genetic alterations and the potential influence of environmental factors for EOPC are to be further investigated.
Annals of Gastroenterology 05/2011; 24(3):206-212.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.