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First Evidence That Endoscopic Ultrasound Improves Survival in Pancreatic Cancer: Presented at DDW

By Bruce Sylvester

SAN DIEGO -- May 26, 2008 -- Researchers reported the first evidence that use of endoscopic ultrasound (EUS) improves outcomes in patients with pancreatic cancer, according to findings presented here at Digestive Diseases Week 2008 (DDW).

As background, the researchers noted, "EUS is often utilised in the evaluation of patients with pancreatic cancer although there is no direct evidence that EUS improves patient outcome."

The study was conducted to investigate the association of EUS with survival in patients with pancreatic adenocarcinoma.

"We found that accurate initial investigation using EUS could make a significant difference for patients with pancreatic cancer," said investigator Ananya Das, MD, Associate Chair of Medicine, Mayo Clinic, Scottsdale, Arizona, at a press briefing on May 20. "It should be included, when possible, in treatment planning."

The investigators identified data on patients aged 66 years or older with a recent diagnosis of pancreatic cancer who were entered in the linked Surveillance Epidemiology and End Results - Medicare database between January 1994 and December 2002. They extracted demographic, cancer-specific information, and EUS procedural information.

Survival curves for patients who underwent EUS within 90 days of diagnosis (EUS group) were compared with those who had no EUS (no-EUS group). They used standard statistical analysis tools to assess the independent association of EUS and survival.

They identified 4,236 patients with locoregional pancreatic adenocarcinoma. Of these, 535 (12.6%) had undergone EUS evaluation.

Median survival (inter-quartile range) in the EUS group and the no-EUS group were 9 (4-17) and 5 (2-11) months, respectively (P < .0001).

The proportion of patients with regional disease was higher in the EUS group than in the no EUS group (81% vs 75%, P < .01).

Curative intent surgery (23% vs 10%, P < .001) and radiation treatment (18% vs 11%, P < .001) were also performed more frequently in the EUS group.

After adjusting for age at diagnosis, race, gender, comorbidity score, and tumour stage, the researchers found that EUS was an independent predictor of improved survival (relative hazard, 0.82; 95% confidence interval, 0.73-0.90).

The authors noted, "This is the first evidence that EUS evaluation is associated with improved outcome in patients with pancreatic cancer."

"Receipt of EUS in patients with locoregional cancer is independently associated with improved survival, possibly because of detection of earlier cancers or improved stage-appropriate management including more selective performance of curative intent surgery," they concluded.


[Presentation title: Endosonographic Evaluation Improves Survival in Patients With Pancreatic Cancer. Abstract 762]

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