Prognosis
Resectable disease (stage 1, 2)
At the time of diagnosis, 10% to 15% of patients have resectable disease.[153] However, even in patients who have undergone radical pancreatic resection, median survival ranges from 15 to 19 months, with a 5-year survival rate of about 20%. The strongest prognostic indicators for long-term patient survival include negative resection margins, tumour DNA content, tumour size, and absence of lymph node metastases.[78]
Unresectable locally advanced disease (stage 3)
About 30% to 35% of patients present with locally advanced pancreatic cancer.[153] Although chemotherapy with or without radiotherapy may give a modest improvement in survival and palliation, it rarely controls the cancer. Within months of completion of treatment, patients frequently have evidence of local tumour progression or new metastatic disease.[78] These patients most probably harboured sub-clinical metastatic disease and should be considered for treatment with novel agents. The prognostic impact of molecular factors, such as K-Ras, epidermal growth factor receptor, PTEN, or AKT, and detection of circulating tumour cells is under evaluation.[154]
Metastatic disease (stage 4)
Patients with metastatic disease (50% to 55%) have a limited survival of only 3-6 months. Survival is dependent on tumour burden and performance status at presentation.[78]
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