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Boo, Kim, Kim, Ryu, Kim, Park, Lee, Seo, Lee, Kim, and Han: Clinical Characteristics of Pancreatic Metastases
Original Article

Korean J Gastroenterol 2011;57(6):358-364.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.57.6.358

Clinical Characteristics of Pancreatic Metastases

Sun-Jin Boo, Myung-Hwan Kim, Yu Seok Kim, Choong Heon Ryu, Hong Jun Kim, Do Hyun Park, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Song Cheol Kim1, Duck Jong Han1

Department of Internal Medicine and Surgery, University of Ulsan College of Medicine, Seoul, Korea

1Department of Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to: Myung-Hwan Kim, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3183, Fax: +82-2-476-0824, E-mail: mhkim@amc.seoul.kr

Received 25 March 201030 December 2010       Accepted 30 December 2010

Copyright © 2011 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Histologically confirmed metastatic pancreatic cancers are infrequent. The aim of this study was to analyze clinical, therapeutic and prognostic features of pancreatic metastases.

Methods

We retrospectively evaluated stage of primary malignancies, interval between diagnosis of primary tumors and detection of pancreatic metastases, treatment for metastases to the pancreas, survival rate, and prognostic factors in 31 patients with pancreatic metastases.

Results

The mean age at the time of primary cancer diagnosis was 52.4±13.2 years. Primary cancers were renal cell carcinoma (n=16), non-small cell lung cancer (n=6), small cell lung cancer (n=3), colorectal carcinoma (n=2), osteosarcoma (n=1), gastric carcinoma (n=1), malignant melanoma (n=1), and thymic carcinoma (n=1). Pancreatic metastases were synchronous in six cases and metachronous in twenty five cases, with median interval time of 40.8 months (range 3-186) between the diagnosis of primary tumor and detection of pancreatic metastases. The median survival after the detection of the metastases was 16 months. In multivariate analysis, non-renal cell carcinoma as primary malignancy and positive symptom related to pancreatic metastases were associated with poor prognosis (hazard ratio [HR], 8.33; 95% CI, 2.1-33; p=0.003, and HR, 4.02; 95% CI, 1.27-12.7; p=0.018).

Conclusions

Metastatic tumors to the pancreas have to be kept in mind when a patient with pancreatic mass has a history of other malignancy, even if treated several years before. In the absence of widely metastatic disease, aggressive diagnostic and therapeutic approach may offer the chance of long-term survival in selected patients.

Keywords: Pancreatic metastasis, Carcinoma, renal cell, Survival

References

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Fig. 1.
Kaplan-Meier survival curve after detection of pancreatic metastases. The median survival for patients with pancreatic metastases was 16 months.
kjg-57-358f1.tif
Fig. 2.
Survival comparison between patients with pancreatic renal cell carcinoma metastases and patients with pancreatic non-renal cell carcinoma metastases. Renal cell carcinoma as primary cancer was associated with prolonged survival (mean 52 vs. 12 months, p=0.001).
kjg-57-358f2.tif
Fig. 3.
Survival comparison between ≤2 years interval and >2 years interval between diagnosis of primary tumors and detection of pancreatic metastases. The interval of more than 2 years was associated with prolonged survival (mean 51 vs. 14 months, p=0.001).
kjg-57-358f3.tif
Table 1.
Clinical Findings of 31 Patients with Metastases to the Pancreas
Case No. Sex/Age Dx Primary treatment Interval between primary Dx and detection of metastases (months) Sx Site of pancreatic metastases Extra-pancreatic metastases Treatment after metastases
1 M/59 RCC Surgery+Immuno 60 No Diffuse Lung Chemo+Immuno
2 M/60 RCC Surgery 132 Jaundice Head+Tail Lung Supportive
3 M/41 RCC Surgery 132 No Head Lung Immuno+RTx to lung
4 F/60 RCC Surgery+Immuno 129 No Body No Surgery
5 M/59 RCC Surgery+Chemo Synchronous No Diffuse Lung, Adrenal Surgery+Chemo
6 M/67 CRC Surgery+Chemo+RTx 73 No Tail Lung Surgery+SRS to lung
7 M/45 RCC Surgery 127 No Body No Surgery
8 M/37 NSCLC Palliative Chemo Synchronous No Tail No Palliative Chemo
9 M/50 RCC Surgery+Chemo+Immuno o 41 No Head Lung Surgery+Chemo
10 M39 RCC Surgery+Chemo 38 Abdominal pain Body+Tail Lung Supportive
11 M/38 AGC Surgery+Chemo 40 No Tail No Surgery+Chemo
12 M/28 Thymic cancer Surgery+Chemo+RTx 26 No Body+Tail Brain Supportive
13 M/67 NSCLC Surgery+RTx 4 Abdominal pain Diffuse Lung Supportive
14 M/44 CRC Surgery+Chemo 39 No Tail No Surgery+Chemo
15 M/70 NSCLC Palliative Chemo Synchronous Indigestion Body No Palliative Chemo
16 M/54 RCC Surgery+RTx 117 Wt. loss Head No Surgery
17 M/44 NSCLC Surgery+RTx 12 No Tail Umbilicus Surgery+Chemo
18 M/65 RCC Surgery+Chemo+RTx Synchronous Abdominal pain Tail No Supportive
19 M/64 RCC Surgery 110 No Diffuse Lung Palliative Chemo
20 M/70 RCC Surgery 186 No Tail Liver Palliative Chemo
21 F/44 RCC Surgery 42 No Body+Tail No Surgery+Chemo
22 F/51 RCC Palliative Chemo Synchronous Abdominal discomfort Body+Tail Lung Palliative Chemo
23 M/47 RCC Surgery 151 No Tail No Surgery+Chemo
24 M/44 SCLC Chemo+RTx 15 Jaundice Head No Palliative Chemo
25 M/48 NSCLC Surgery+Chemo 12 No Tail No Supportive
26 M/35 Melanoma Surgery+Chemo 145 Jaundice Head No Supportive
27 M/57 RCC Surgery+Immuno 3 Indigestion Tail No Surgery+RTx
28 M/75 SCLC Palliative Chemo Synchronous Jaundice Head No Palliative Chemo
29 M/61 SCLC Chemo+RTx 10 No Head Liver Palliative Chemo
30 M/27 Osteosarcoma Surgery+Chemo+RTx 20 Abdominal pain Body No Surgery
31 M/73 NSCLC Surgery 5 Jaundice Head No Supportive

No., number; Dx, diagnosis; Sx, symptom; Chemo, chemotherapy; Immuno, immunotherapy; RTx, radiotherapy; RCC, renal cell carcinoma; CRC, colorectal cancer; NSCLC, non-small cell lung cancer; SCLC, small cell lung cancer.

Table 2.
Univariate Analysis for Potential Predictors of Overall Survival after Detection of Pancreatic Metastases
Potential prognostic factors Overall survival (months, mean) p-value
Primary tumor    
 RCC (n=16) 51.5 0.001
 Non-RCC (n=15) 11.9
Positive Sx related to pancreatic metastases    
 Yes (n=13) 23.6 0.072
 No (n=18) 44.7
Interval from diagnosis of primary tumor to detection of pancreatic metastases    
 ≤2 years (n=12) 14.1 0.001
>2 years (n=19) 51.4
No. of pancreatic metastases    
 Solitary (n=22) 29.9 0.458
 Multiple (n=9) 41.5
Treatment    
 With surgery (n=12) 40.7 0.153
 Without surgery (n=19) 29.6

RCC, renal cell carcinoma; Sx, symptom; No., number.

Table 3.
Multivariate Analysis for Potential Predictors of Overall Survival after Detection of Pancreatic Metastases
Potential prognostic factors HR 95% CI p-value
Non-RCC as primary tumor 8.33 2.10 to 33.00 00.003
Positive Sx related to pancreatic metastases 4.02 1.27 to 12.70 00.018
≤2 years interval from diagnosis of primary tumor to detection of pancreatic metastases 2.61 0.90 to 7.55 0.077

RCC, renal cell carcinoma; Sx, symptom; HR, hazard ratio; CI, confidence interval.

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