Furthermore, we explored the prognostic factors of pancreatic cancer metastasis to liver grouped by age at diagnosis. Tumor grade, histology and treatment are valid prognostic factors in all age groups. Conclusion: Our study evaluated the predictors of patients with pancreatic cancer metastasis to liver at various ages of diagnosis. The liver is the most frequently afflicted metastatic organ second to the lymph nodes for most malignancies Jaques et al. Because lesions are usually asymptomatic, liver involvement in metastasis is often neglected and poorly studied, and even extensive infiltration of metastatic tumor may not alter its function or homeostasis until late in the disease Clark et al.
As one of the deadliest malignant tumors in the world Ferlay et al. In decades, a large number of studies have shown that the development of pancreatic cancer was closely related to age. The aging trend of the population in the world is challenging the current treatments and caring for patients with pancreatic cancer Bray et al. The underlying mechanisms of pancreatic cancer is complicated and uncertain, accompanied with poor prognosis Maisonneuve, According to the original site in pancreas, pancreatic cancer is classified as endocrine and exocrine pancreatic cancer, and the latter is more common and has a higher risk of mortality in both females and males Fesinmeyer et al.
Additionally, the majority of exocrine pancreatic cancer is adenocarcinoma Li, ; Cowgill and Muscarella, Previous studies suggested risk factors of pancreatic cancer involving smoking, positive family history and genetics, diabetes, obesity, dietary factors, alcohol consumption, and physical inactivity Yadav and Lowenfels, ; Ilic and Ilic, Age, race, tumor size, grade, lymph node metastasis Mayo et al.
However, evidence for prognostic factors in pancreatic cancer with distant metastasis is rare. Moreover, Andrew A et al. Thus, the objective of this study is to determine the differences in primary sites of metastatic liver cancer between males and females. Furthermore, we evaluated the prognostic risk factors of pancreatic cancer metastasis to liver at different ages of diagnosis through the Cox regression model. The program contains the population-based central cancer registries of 18 geographically defined regions.
Because all the data used in the study was retrieved from the SEER database with publicly available methods, the study did not require local moral approval or a declaration.
The inclusion criteria included: 1 The disease was diagnosed between and ; 2 metastases of the primary tumor were at the liver; 3 there was only one primary tumor; 4 the diagnosis of the disease was histologically positive; 5 there were more than 0 days of survival.
Figure 1. We used the histopathology codes from the International Classification of Disease for Oncology third edition ICD-O-3 to define the primary sites of patients with hepatic metastatic carcinoma. Information on demographic factors age, race, sex and marital status , tumor-related factors tumor size, grade, histology and AJCC TNM staging system , therapeutic factors surgery and chemotherapy and follow-up were collected from the SEER database.
And follow-up period ended in Based on the Surgery Codes of the SEER program and information about other treatments, we divided the treatment options into categories: no treatment N , surgery alone S , chemotherapy alone C , surgery combined with chemotherapy SC. OS was measured from the date on which the first-time definite diagnosis was made until the date of death caused by any cause or the most recent follow-up.
Age and tumor size are categorized according to the best cut-off value produced by the x-tile software version 3. S2 The incidence rates were calculated by using R software. The independent risk factors were identified by univariate and multivariate Cox proportional-hazards regression analyses for OS.
R software version 4. Regardless of gender, the most common primary site of hepatic metastatic carcinoma was lung and brunchu that accounted for Table 1. In females, the top five most common primary lesions of hepatic metastases were breast Figures 2 , 3. TABLE 1. The frequency distribution of primary lesions of metastatic liver cancer. Frequency Distribution of primary tumour sources of hepatic metastatic carcinoma.
The purpose of primary tumour sources of liver metastatic carcinoma in both sexes. The overall survival time was negatively correlated with the age at diagnosis. Among the three groups, the prognosis of patients diagnosed at age less than 52 years old was the best, and of which the median survival time was 1 year. Figure 4. Kalpan Meier survival curve showing the effect of age at diagnosis with pancreatic cancer metastasis to liver.
And the median survival time of patients with surgery alone was approximately 3. Figure 5. Kalpan Meier survival curve showing the effect of treatment with pancreatic cancer metastasis to liver. As the multivariable hazard ratio of in prognosis displayed in Figure 6 , with the increase of the age of diagnosis, treatment showed significantly protective effect, while grade had a significant effect on prognosis only in younger age.
And other prognostic factors had almost no significant change. Figure 6A. Thus, we further analyzed the relative hazard ratio of diverse treatment options and age of diagnosis in patients, we found that when patients were diagnosed at a younger age, chemotherapy alone was the most adverse risk factor, while when diagnosed at an older age, age at diagnosis was the most adverse risk factor for the outcome. Figure 6B. Relative hazard ratio of multivariables in patients with pancreatic cancer metastasis to liver.
Demographic characteristics of patients with pancreatic cancer metastasis to liver grouped by age at diagnosed during the years study period between and in the SEER database are shown in Table 2.
On the whole, most patients were married white males whose tumors were poorly differentiated and less than 4. The most common histological type of tumors was adenomas and adenocarcinomas. TABLE 2. Clinical characteristics of the patients with pancreatic cancer metastasis to liver grouped by age at diagnosis. TABLE 3. Univariate and multivariate of OS in the patients with pancreatic cancer metastasis to liver grouped by age at diagnosis.
In the three groups, tumor grade was all associated with poor overall survival, and surgery alone S was the best treatment option for the overall survival of patients. TABLE 4. Univariate and multivariate of CSS in the patients with pancreatic cancer metastasis to liver grouped by age at diagnosis. Using well differentiated grade as reference, multivariate analysis in Table 4 indicated tumor grade was associated with poor overall survival at different ages. In addition, treatment S, C, SC was associated with better cancer-specific survival in all three groups compared with no treatment.
The formation of local infiltrates and metastases are clinically most relevant to the progression of cancer Christofori, Organ damage due to growth-related lesions, paraneoplastic syndromes, or treatment complications was significantly associated with morbidity and mortality of metastatic disease Steeg, In general, cancer metastasis can be divided into different stages from local invasion, intravasation, survival in circulation, extravasation, finally to colonization and metastasis Hanahan and Weinberg, The unique biological characteristics of the liver make it a vulnerable site for tumor metastasis: 1 structural and hemodynamic features - characteristic microcirculation in the liver makes it easier for diffuse tumor cells carried in the blood to enter.
In addition, molecules on the surface of hepatic nonparenchymal cells NPCs lining the hepatic capillaries contribute to the adhesion and retention of circulating tumor cells. The pore on the hepatic sinusoidal endothelial cell LSECs facilitates the tumor cells to enter the basement membrane directly; 2 regenerative capabilities—the cellular tissue remodeling mechanism involved in self-renewal and reconstruction that promotes intratumoral stroma and blood vessel formation through signals generated by tumor cells, creating an enabling environment for survival and growth; 3 regional immunosuppression—the general foreign body reaction is reduced to limit potential damage to the liver, resulting in a relatively tolerant microenvironment that allows for the survival and growth of foreign tumor cells Vidal-Vanaclocha, ; Clark et al.
Pancreatic cancer is the fourth leading cause of cancer-related death worldwide, and its main metastatic site is liver Stott et al. Studies have shown that, in addition to smoking, a family history of pancreatic cancer, black race, diabetes, and increased body mass index were also predictors of pancreatic cancer mortality Coughlin et al.
A lack of early signs and symptoms, as well as high aggressiveness, leads to a low survival rate. Our present data showed tumor grade was also a significant predictor of overall survival and cancer-specific survival in patients with liver metastasis, independent of age at diagnosis Table 3 , Table 4. Histologically, pancreatic adenocarcinoma accounts for the largest proportion in pancreatic cancer Simard et al.
Our data suggested that most histologic types of pancreatic metastases to liver were adenocarcinomas. The prognosis of patients with pancreatic cancer with liver metastasis was poorer than that of patients with distant lymph node metastasis or lung metastasis. Furthermore, our study showed that the younger the age, the higher the overall survival rate of patients with pancreatic cancer with liver metastasis Figure 4. In addition, we found differences in prognostic factors among the groups after grouping by age at diagnosis.
Table 3 , Table 4. At present, the only treatment for pancreatic cancer is surgery, and adjuvant therapy based on chemotherapy can improve the survival rate McGuigan et al. Surgery is limited to patients with localized disease, and metastatic spread is often considered a contraindication to resection, regardless of whether it is observed synchronously or ectopic Seufferlein et al.
However, metastatic excision or local treatment is occasionally performed in centers around the world based on individual clinical experience, and there is no objective evidence to guide treatment methods taking into account patient choice or metastatic spread Gleisner et al. Despite this, T. Back pain is another one, because the pancreas is very posterior in the body. Back pain is also the most common complaint that patients go to an emergency room for, and most of the time it's just muscle pain—it's not pancreatic cancer.
The press reported that Upshaw's wife brought him to the hospital because he was having trouble breathing. What might have caused that? It could be for a number of reasons, such as if the disease has spread to the lungs. If he was so run-down from having lost a significant amount of weight, and he was weak and fatigued, he could have had difficulty breathing, too.
It's hard to say. Another important thing with pancreatic cancer is that it's one of the cancers that is frequently associated with blood clots. He could have had a blood clot in the lung, called a pulmonary embolism. It's possible that that's what killed him. What treatments are available if surgery isn't an option?
Chemotherapy and radiation therapy. Sometimes we do both together. We are also using biologic agents now, meaning antibody therapy. There's a drug called Tarceva , which is an antibody [or immune protein] against the growth factor that the tumor cell makes, and so it blocks that growth signal. It's given in combination with [a chemotherapy called] Gemcitabine. In a large randomized clinical trial , [the combination of the two drugs] was shown to improve upon Gemcitabine alone.
Already a subscriber? Sign in. Thanks for reading Scientific American. Create your free account or Sign in to continue. See Subscription Options. Go Paperless with Digital. Get smart. Sign up for our email newsletter. These people often have little or no appetite. If the cancer presses on the far end of the stomach it can partly block it, making it hard for food to get through.
This can cause nausea, vomiting, and pain that tend to be worse after eating. If the cancer blocks the bile duct, bile can build up in the gallbladder, making it larger. Sometimes a doctor can feel this as a large lump under the right side of the ribcage during a physical exam.
It can also be seen on imaging tests. Pancreatic cancer can also sometimes enlarge the liver, especially if the cancer has spread there.
The doctor might be able to feel the edge of the liver below the right ribcage on an exam, or the large liver might be seen on imaging tests. Sometimes, the first clue that someone has pancreatic cancer is a blood clot in a large vein, often in the leg. This is called a deep vein thrombosis or DVT. Symptoms can include pain, swelling, redness, and warmth in the affected leg. Sometimes a piece of the clot can break off and travel to the lungs, which might make it hard to breathe or cause chest pain.
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