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

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.