Pancreatitis prognosis

Despite the potential for better local-regional control using preoperative or adjuvant chemoradiotherapy, the prognosis of pancreatic cancer remains poor. Treatment failure is primarily due to distant metastases. Also, the progress in the treatment of pancreatic cancers is hindered by the absence of effective systemic agents. New approaches continue to be developed that hopefully will alter the natural history of this disease. 

Clinical Efficiency of Tests in the Early Assessment of the Prognosis of Acute Pancreatitis"1... 

P7. Pezzilli, R., Miniero, R., Cappelletti, O., and Barakat, B., Serum interleukin 6 in the prognosis of biliary acute pancreatitis. Ital. J. Gastroenterol. Hepatol. 30, 291-294 (1998). 

Hamori J, Arkosy P, Lenkey A, Sapy P, The role of different tumor markers in the early diagnosis and prognosis of pancreatic carcinoma and chronic pancreatitis, Acta. Chir. Hung., 36 125-127, 1997. 

Morbidity should not exceed 30%. Lethality is between 0-3%. The 5-year survival rate following RO resection in metastatic colorectal carcinoma is 20-40%, in neuroendocrine tumours 90-100%, in malignant melanoma 15-25%, and in breast cancer 10-30%. Prognosis is poor in metastasizing renal cell carcinoma and in gastric or pancreatic carcinoma. Both R1 and R2 resection worsen the prognosis to the same extent. 

Increased Utilization. Secondarily low levels of AAT are seen in the neonatal respiratory distress syndrome, severe neonatal hepatitis, and severe preterminal disease of the pancreas. In nonfatal pancreatitis, levels increase along with those of other APR, and increased levels of complexes with trypsin are probably a better marker for use in either differential diagnosis or prognosis in patients with possible pancreatitis. 

Telomerase activity has been detected in more than 80% of cancers, including lung, breast, pancreatic, bladder, and many other cancers however, it does not seem to be necessary for cancer development. Its activity does, however, correlate with tumor progression and prognosis. 

Cystic fibrosis (CF) is the most common severe autosomal recessive disease, with an estimated gene frequency in Western Europe and the United States of between 1 25 and 1 35 and a disease incidence of about 1 in 2500 to 1 in 3200. The pathogenesis and diagnosis of CF are described in Chapter 40. Pancreatic insufficiency is present at birth in 65% of infants with CF, and a further 15% develop it during infancy and early childhood. The 20% who do not develop pancreatic insufficiency have a better prognosis and develop fewer complications. 

ErbB-2 is frequently overexpressed in pancreatic adenocarcinomas, specifically in well- or moderately differentiated glandular areas of the tumor, and is decreased in the poorly differentiated areas (Dugan et al., 1997 Yamana-ka et al., 1993b). Overexpression was linked with worse prognosis in ampulla of Vater tumors (Vaidya et al., 1996a,b). 

Pancreatitis MMP-1 Serum/High Poor Poor prognosis (T2)... 

Vogel, I., and Kalthoff, H., Disseminated tumour cells. Their detection and significance for prognosis of gastrointestinal and pancreatic carcinomas. Virchows Arch. 439, 109-117 (2001). 

Adenocarcinoma of the pancreas in childhood is exceedingly rare, with the majority of patients diagnosed between 3 and 18 years. Abdominal pain and mass are the most common manifestations in the initial exam. This tumor has a bad prognosis in children, and patients with Peutz-Jeghers syndrome have been associated with a higher risk (xlOO-fold) of pancreatic adenocarcinoma. 

Kaiser MH, Barkin J, MacIntyre JM (1985) Pancreatic cancer. Assessment of prognosis by clinical presentation. Cancer 56 397-402... 

---