Survival in patients with pancreatic cancer after the diagnosis of malignant ascites or liver metastases by EUS-FNA

Background The expected survival after the EUS-FNA diagnosis of malignant ascites or liver metastases from pancreatic cancer is not known. Objective To report overall and 1-year survival in these patients. Design Retrospective cohort series. Setting Tertiary referral hospital. Patients Consecutive subjects with newly diagnosed pancreatic cancer from June 1998 and March 2008 in whom EUS-FNA of the liver or ascitic fluid confirmed hepatic metastases or malignant ascites. Interventions Calculation of survival after diagnosis by using the Social Security Death Index. Main Outcome Measurements Survival after EUS-FNA diagnosis of stage IV pancreatic cancer. Results EUS-FNA identified liver metastases and malignant ascites from primary pancreatic cancer in 75 and 13 patients, respectively, and all 88 died during follow-up. For all 88 patients, the 1-year survival rate and median survival were 3.4% (95% CI, 1.1%-10.4%) and 82 days (range 2-754 days), respectively. The 1-year survival rates for those with liver metastases (4.0% [95% CI, 1.3%-12.1%]) and for those with malignant ascites (0% [95% CI, 0-24.7%]) were similar ( P = 1.0). The median survival for patients with liver metastases of 83 days (range 2-754 days) was similar to that for those with malignant ascites (64 days; range 2-153 days) ( P = .13). No clinical variable considered predicted survival of more than, less than, or 3 months. Limitations Retrospective series with variable treatment for malignancy. Conclusions In patients with pancreatic cancer, identification of malignant ascites or liver metastases by EUS-FNA is associated with a very poor prognosis.