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Predicting factors for unresectability in patients with pancreatic ductal adenocarcinoma
Ken-ichi Okada1, Manabu Kawai, Masaji Tani
1Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Background:
The aim of the present study was to identify the predicting factors for unresectability and to clarify who should receive precise evaluations for distant metastasis and locally advanced unresectability in patients with pancreatic ductal adenocarcinoma (PDAC).
Methods:
A total of 200 consecutive patients with PDAC who presented to the outpatient clinic between June 2009 and October 2012 were analyzed retrospectively. Clinical factors and the serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, DUPAN-2 (pancreatic cancer-associated antigen) and CA 125 were analyzed.
Results:
Of the 200 patients who were investigated for PDAC, 60 (30%) were initially considered unresectable (15 patients with locally advanced tumors, 45 patients with distant metastases). Of the 136 (68%) patients who were surgically explored, 19 (9.5%) were detected to have minute metastases on laparotomy. A multivariate analysis revealed that tumor size (≥30 mm) and abnormalities in the levels of DUPAN-2 and CA 125 were independent predictors of unresectability (P = 0.002, 0.014, < 0.001, respectively). The patients with triple positive findings presented with the highest sensitivity (78.8%) for unresectability.
Conclusions:
Patients with triple positive findings for a tumor size ≥30 mm, abnormalities in the levels of DUPAN-2 and CA 125 should receive precise evaluations for unresectability.
