Stages and Prognostic Factors of Pancreatic Cancer after Resection

Park, Sang Jae

Abstract

In Korea, the incidence of pancreatic cancer was 9th and the mortality was 5th in 2002. The unique modality to cure is a surgery, however the resectability is around 10~20%. The survival data of pancreatic cancer after resection in '60s ~'70s were disappointing; operative mortalities were as high as 20~30% with 5-year survival rates were about 5%. However, from '90s, there have been several papers which reports the operative mortalities less than 5% and the 5-year survival rates over 20% after resection. However it is not clear whether survival in pancreatic cancer after surgery has been really improving or not. Prognostic factors in pancreatic cancer after resection can be classified into 3 categories; factors related to the patient, the tumor and the surgeon. At present, the most important prognostic factors are tumor factors such as tumor size, lymph node metastasis, depth of invasion, and histological differentiation. The factors related to the minimal residual disease or molecular biologic studies would get more concern. Staging in the malignancy is very important in predicting the prognosis and determining the adjuvant therapies. Good stages should be a good prognosis predictor and be simple as well. In pancreatic cancer, TNM staging from AJCC/UICC has been used worldwide and the 6th edition was published in 2001. JPS (Japanese pancreatic society) staging for pancreatic cancer, compared to AJCC staging, is better in predicting the prognosis but somewhat complicated. Studies for the prognostic factors and staging for Korean pancreatic cancer cases should be followed.