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Open Access Research article

Tumor size as measured at initial X-ray examination, not length of bile duct stricture, predicts survival in patients with unresectable pancreatic cancer

Henrik Forssell12*, Katrin Pröh3, Michael Wester1 and Hans Krona4

Author Affiliations

1 Dept of Surgery, Blekinge Hospital, 371 85, Karlskrona, Sweden

2 Blekinge Centre of Competence, Blekinge, 371 81, Karlskrona, Sweden

3 Dept of Radiology, Blekinge Hospital, 371 85, Karlskrona, Sweden

4 Blekinge Institute of Technology, School of Health Science, 371 79, Karlskrona, Sweden

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BMC Cancer 2012, 12:429  doi:10.1186/1471-2407-12-429

Published: 25 September 2012

Abstract

Background

The survival of unresectable pancreatic cancer patients is extremely poor. The aim of this study was to examine if tumor size could predict survival length in order to optimize patient care.

Methods

A retrospective observational study was performed on 185 consecutive patients with unresectable pancreatic cancer (ICD10: C250-2 and C258) who were diagnosed from 2003 to May 2010. The patients' initial radiographs at presentation of symptoms were reviewed by the same radiologist, and tumor extent was determined.

Results

The largest tumor diameter of the primary tumor was measured in 132 patients, 22 by an ultrasound and the other patients by a CT scan. In 53 patients, the tumor size could not be delimited and measured. Seventy-five patients (41%) had liver metastases at presentation of symptoms. Median survival for the entire patient group was only 119 days. The median diameter of the patient’s largest tumor was 4.35 cm, while the sample groups ranged from 1.2 to 14 cm. Patients were divided into two groups: those with a largest tumor diameter of ≤ 4.3 cm (66 patients) and those with a largest tumor diameter of > 4.3 cm (66 patients). Median survival for these groups was 149 and 94 days (p = 0.019), respectively. Cox regression showed a hazard ratio for tumor size of 1.48 (95% CI 1.02, 2.07) (p = 0.038), adjusted for the gemcitabine treatment which had been given to 49 patients and the presence of liver metastasis. In 88 patients, stricture length could be measured at ERCP. When comparing stricture lengths of ≤ 2 cm and > 2 cm, no difference in survival time was noted within a Kaplan-Meier analysis.

Conclusion

The size of the maximum tumor diameter of the primary tumor during the initial X-ray examination of patients with pancreatic cancer may predict survival time for those patients who had no surgical resection. Stricture length at ERCP gave no information on survival.

Keywords:
Pancreatic cancer; Pancreatic neoplasm; Unresectable; Tumor size; Biliary stricture; Palliative; Survival; Prediction of survival