Survival in patients with pancreatic cancer after the diagnosis of malignant ascites or liver metastases by EUS-FNA

Received 9 June 2009; accepted 23 August 2009. published online 18 November 2009.

Refers to article:

Continuing Medical Education Exam: February 2010
Raquel E. Davila, Jeffrey H. Lee, William Ross, Shou-Jiang Tang, G.S. Raju, Glenn M. Eisen
Gastrointestinal Endoscopy
February 2010 (Vol. 71, Issue 2, Pages 365-365.e6)
Full-Text PDF (299 KB)

Background

The expected survival after the EUS-FNA diagnosis of malignant ascites or liver metastases from pancreatic cancer is not known.

Objective

To report overall and 1-year survival in these patients.

Design

Retrospective cohort series.

Setting

Tertiary referral hospital.

Patients

Consecutive subjects with newly diagnosed pancreatic cancer from June 1998 and March 2008 in whom EUS-FNA of the liver or ascitic fluid confirmed hepatic metastases or malignant ascites.

Interventions

Calculation of survival after diagnosis by using the Social Security Death Index.

Main Outcome Measurements

Survival after EUS-FNA diagnosis of stage IV pancreatic cancer.

Results

EUS-FNA identified liver metastases and malignant ascites from primary pancreatic cancer in 75 and 13 patients, respectively, and all 88 died during follow-up. For all 88 patients, the 1-year survival rate and median survival were 3.4% (95% CI, 1.1%-10.4%) and 82 days (range 2-754 days), respectively. The 1-year survival rates for those with liver metastases (4.0% [95% CI, 1.3%-12.1%]) and for those with malignant ascites (0% [95% CI, 0-24.7%]) were similar (P = 1.0). The median survival for patients with liver metastases of 83 days (range 2-754 days) was similar to that for those with malignant ascites (64 days; range 2-153 days) (P = .13). No clinical variable considered predicted survival of more than, less than, or 3 months.

Limitations

Retrospective series with variable treatment for malignancy.

Conclusions

In patients with pancreatic cancer, identification of malignant ascites or liver metastases by EUS-FNA is associated with a very poor prognosis.

Indianapolis, Indiana, USA

Abbreviation: SEMS, self-expanding metallic stent

Current affiliations: Division of Gastroenterology and Hepatology (J.D., M.A.A., S.S., L.M., J.K.L.), Department of Biostatistics (M.Y.), Indiana University Medical Center, Indianapolis, Indiana, USA

Reprint requests: John DeWitt, MD, FACP, FASGE, Division of Gastroenterology and Hepatology, Indiana University Medical Center, 550 North University Blvd., UH 4100, Indianapolis, IN 46202.

DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

See CME section; p. 365

If you would like to chat with an author of this article, you may contact Dr. DeWitt at jodewitt@iupui.edu.

PII: S0016-5107(09)02425-0

doi:10.1016/j.gie.2009.08.025

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