[Value of combined therapy in pancreatic cancer with a poor prognosis: analysis of 233 clinical cases].

Objective: To analyze the value of combined therapy in pancreatic cancer with a poor prognosis.

Methods: The prognostic factors of pancreatic cancer with different clinicopathological characteristics and treatment modalities were analyzed retrospectively and the cumulative curve was plotted using the Kaplan-Meier method.

Results: (1) From January 2001 to December 2005, 233 patients with pathological and cytological diagnosis of pancreatic cancer were analyzed. The median survival of all patients was 8.67 months, the 1-year survival rate 29.6% and the 5-year survival rate 4.5%. (2) Weightloss cases had a median survival of 7.7 months versus 10.0 months for cases without weightloss (P = 0.003). Back pain cases had a median survival of 6.5 months versus 9.0 months for cases without back pain (P = 0.015). Cases with normal CA19-9 levels (< or = 37 U/ml) had a median survival of 11.0 months versus 8.0 months for cases with CA19-9 > 37 U/ml levels (P = 0.000). Stages III and IV disease cases had a median survival of 8.7 and 6.3 months versus 16.0 months for cases of Stages I + II (P = 0.000). In the present study, patients suffering from weightloss or back pain or whose CA19-9 was above 37 U/ml or whose TNM stage was III/IV were defined as cases with a poor prognosis. (3) Patients were grouped as pancreatectomy group, cancer-directed treatment group (including intraoperative iodine-125 seed interstitial brachytherapy, 5-FU interstitial chemotherapy, radiotherapy, chemotherapy and transcatheter arterial infusion chemotherapy) and no cancer-directed treatment group (including cases receiving biopsies or bypass). Median survival of three groups were 14.0, 8.3 and 6.6 months respectively. And the 1-year survival rates were 53.5%, 22.5% and 11.8% respectively while the 5-year survival rate 5.8%, 0 and 0 respectively. (4) Median survival of poor prognostic cases (who suffered from weightloss or back pain or whose CA19-9 was above 37 U/ml or whose TNM stage was III/IV) treated with pancreatectomy were 12.0, 11.0, 12.0 and 7.0 months respectively. Median survival of poor prognostic cases treated with cancer-directed therapy were 7.7, 7.5, 8.6 and 8.0 months respectively. Median survival of poor prognostic cases treated with no cancer-directed therapy were 4.0, 3.0, 4.0 and 4.6 months respectively.

Conclusion: Optimized combined therapy is recommended for pancreatic cancer patients with poor prognostic factors.