Endoscopic ultrasound prediction of survival in pancreatic cancer

Endoscopic ultrasound (EUS) has been shown to be the most accurate imaging modality for preoperative T- and N-staging in pancreatic cancer. Pancreatic cancer (PanCa) often presents at an advanced stage, but a subset of patients may be cured by surgery. We prospectively followed patients after EUS for PanCa staging to determine the utility of EUS in predicting survival. Methods: 150 consecutive patients who underwent EUS (Olympus GF-UM20) for PanCa over a 42 month period were reviewed. Survival data was obtained on 93 patients. Results: All patients with T1 lesions (13) were alive at the time of this study. Results for all other lesions are presented below. For those with complete surgical pathologic staging, EUS had a 76% T-stage accuracy and a 66% N-stage accuracy. There was a trend towards improved survival for T2 versus T3 lesions at 15 months (27% for T2, 18% for T3) and 18 months (27% for T2, 9.5% for T3) (p<0.18). There was no trend towards improved survival for NO versus N1 lesions nor for those who underwent Whipple resection versus those who did not. Survival in months by EUS T- and N-staging # Alive 3 mo 6 mo 9 mo 12 mo 15 mo 18 mo T2 30/34 12/22 8/21 6/19 4/15 3/11 T3 40/47 21/40 16/39 8/29 4/22 2/21 NO 25/30 11/23 9/23 8/22 4/16 3/16 N1 45/50 22/39 15/37 6/26 4/21 2/16 Total 70/80 33/62 24/60 14/38 8/37 5/32 Conclusions: 1. EUS had a 77% T-stage accuracy. 2. EUS T-staging may predict long-term survival in pancreatic cancer. With a greater duration of follow-up for our cohort, we expect differences in survival between EUS T-staged pancreatic cancers to become significant. 3. EUS N-staging is not highly accurate (66% in this study), and does not predict long-term survival in this cohort of T-2 and T-3 lesions. 4. A substantial subset of patients (16%) live beyond 1.5 years after the diagnosis of pancreatic cancer regardless of whether a Whipple resection was performed.