June 16, 1995
Media Contact: John Cramer
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Johns Hopkins researchers have identified a group of factors that can accurately predict which patients survive long term after surgery for the most common type of pancreatic cancer.
Results of the study, the largest of pancreatic cancer patients to date, are published in the June issue of Annals of Surgery.
Pancreatic cancer is the fifth leading cause of cancer death in the United States, accounting for more than 25,000 deaths per year. In recent decades, five-year survival rates have increased dramatically from almost zero in the 1960s to more than 20 percent at some medical centers, Hopkins researchers say.
In the study, researchers found that the best predictors of long-term survival after surgical removal of the cancer were a normal chromosome count in the tumor cells; small tumor size; no tumor spread to the lymph nodes; whole tumor removal; surgery in the 1990s; chemotherapy and radiation after surgery; and molecular genetic information, such as minimal or no damage to the p53 tumor-suppressor gene.
"This is a major development, a hopeful sign," says Charles Yeo, M.D., the study's lead author and an associate professor of surgery at The Johns Hopkins Medical Institutions. "More patients are surviving the surgery thanks to better operating techniques and perhaps earlier detection, and now we can tell many patients we operate on when there's reason for hope in the long run."
The study looked at post hospitalization survival rates for 201 Hopkins patients undergoing the Whipple procedure between 1970-1994 to remove the cancerous head of the pancreas. The Whipple procedure, or pancreaticoduodenectomy, involves not only the removal of part of the pancreas, but also the duodenum (a portion of the small intestine), the gallbladder, the bile duct and sometimes part of the stomach.
A study earlier this year concluded that Whipple procedure patients at Hopkins, compared with other Maryland hospitals, had lower in-hospital death rates, spent fewer days in the hospital and paid less because of Hopkins surgeons' high-volume experience. The study involved 501 Hopkins and non-Hopkins patients from 1988-1993.
Five-year survival rates after Whipple procedures have increased from zero in the 1960s -- when some physicians suggested it be abandoned -- to more than 20 percent at some hospitals, including Hopkins, due in part to clinical improvements introduced at Hopkins, according to that study. The overall five-year survival rate in the current study was 21 percent, while the three-year survival rate rose from 14 percent in the 1970s to 21 percent in the 1980s to 36 percent in the 1990s. In a selected subgroup of patients with complete tumor removal and no lymph node spread, the five-year survival rate was 40 percent, one of the highest rates ever reported.
Likely reasons for longer survival, Yeo says, include earlier detection and treatment, better intensive and critical care, more surgical experience, decreased operating time and blood loss, increased use of chemotherapy and radiation after surgery, and the experience associated with a regional specialized medical center.
Hopkins researchers continue to investigate methods of earlier detection of pancreatic cancer, including thorough screening for genetic mutations. Results of a 1994 Hopkins study suggested that mutations of the K-ras gene, which commonly occur in pancreatic cancer, can be detected in stool specimens and may be a candidate for an early diagnostic test. Also, an article by the Hopkins group published in the June 1, 1995, issue of Cancer Research reported the world's largest series of chromosomal abnormalities in patients with pancreatic cancer. Such information is critical for better definition of the molecular genetics of this cancer, Yeo says.
Other authors include John L. Cameron, M.D., Keith D. Lillemoe, M.D., James V. Sitzmann, M.D., Ralph H. Hruban, M.D., Steven N. Goodman, M.D., Ph.D., William C. Dooley, M.D., JoAnn Coleman, R.N., and senior author Henry A. Pitt, M.D.