A prospective evaluation of preoperative endoscopic ultrasound (EUS) staging of pancreatic cancer (PCa) with comparison to patient outcome and survival

F. Gress, T. Savides, S. Ikenberry, S. Sherman, J. Madura, T. Howard, M. Wonn, R. Hawes, G. Lehman

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Abstract

INTRODUCTION: EUS has been shown to be an accurate imaging device to locally stage pancreatic cancer. Our previous retrospective study suggested EUS stage correlated with survival. AIMS OF STUDY: To prospectively evaluate EUS accuracy in staging pancreatic cancer and to compare the EUS stage with survival in both operated and non-operated patients. METHODS: Data was analyzed for 83 consecutive patients between 7/93 - 7/95. Local staging was based on the TNM staging system. 44% (36 pts) went to surgery and in 100% (36 pts) surgical exploration provided local T staging information and in 81% (48/59) local N staging information. Vascular invasion data was obtained in 97% (57/59). Survival data was available in 93% (77/83). RESULTS: OVERALL EUS AND CT STAGING ACCURACY T STAGE N STAGE VASCULAR EUS 84% 70% 95% CT 28% 59% 78% p <0.0001 p <0.0001 p <0.001 SURVIVAL Median Survival (months) Surgery Medical T-1 (N1) 10.0 (n = 2) - T-2 12.6 (n= 14) 13.8 (n = 62) p = 0.067 T-3 8.8 (n=19) 7.7(n = 36) p = 0.11 No 13.5 (n= 18) 7.6(n=10) p = 0.025 N1 8.7(n=17) 8.1 (n = 32) p = 0.97 OveralL 10.8 (n =35) 8.1 (n=42) p=0.065 p = p-value, median age was 67 years. SUMMARY: Our EUS staging accuracy for Pea is similar to previous reports in the literature. EUS was highly accurate in determining vascular invasion. EUS staging of pancreatic cancer appears to correlate with survival; 1) T1 and T2 appear to survive longer than T3. 2). For N0. Vs. N1, (all pts enrolled in study) N0 survived significantly longer than N1 (p =0.025). 3) For N0 disease compared between both groups the operated group survived longer. For N1 disease there was no significant difference in survival between the groups (p=0.97). 5) Overall survival was also not significantly different between the surgery and medical groups (p=0.67). 6) Based upon EUS stage & except for N0 there appears to be no survival benefit between surgery and palliative therapy. CONCLUSION: 1) This is the first prospective study to show correlation between EUS staging and survival data in Pca and supports a role for EUS in staging PCa and in predicting resectability and survival.

Original languageEnglish (US)
Number of pages1
JournalGastrointestinal endoscopy
Volume43
Issue number4
DOIs
StatePublished - Jan 1 1996

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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