Nieman J L, Holmes F F
Department of Medicine, University of Kansas Medical Center, Kansas City 66103.
J Am Geriatr Soc. 1989 Feb;37(2):97-100. doi: 10.1111/j.1532-5415.1989.tb05866.x.
Pancreatic cancer is common in the elderly and often is diagnosed clinically without pathologic confirmation. We compared age distribution and survival of 240 elderly patients with clinically diagnosed pancreatic cancer and 712 elderly patients with pathologically confirmed adeno- and ductal pancreatic carcinoma. All patients were registered by the Kansas state cancer registry from 1975-1984. The percentage of clinical diagnoses increased significantly from 12% in those aged in their 60s to 59% for those in their 90s (P less than .005). Observed 5-year survival for all of the clinically diagnosed patients was 8.4% compared with 0.6% for those pathologically confirmed. When locally confined disease only was considered, 5-year survival was 27% for patients clinically diagnosed and 4% for those pathologically confirmed. Given the fact that long survival from pancreatic carcinoma is a rare event, these findings suggest that in many elderly patients clinical diagnoses of pancreatic cancer are wrong. The findings have implications for the statistics on increasing incidence of pancreatic cancer (particularly in the elderly) and in discussion of prognosis with elderly patients diagnosed with pancreatic cancer without pathologic confirmation.
胰腺癌在老年人中很常见，临床上常常在没有病理确诊的情况下就做出诊断。我们比较了240例临床诊断为胰腺癌的老年患者和712例经病理确诊的胰腺腺癌和导管癌老年患者的年龄分布及生存率。所有患者均由堪萨斯州癌症登记处登记，登记时间为1975年至1984年。临床诊断的比例从60多岁患者中的12%显著增加到90多岁患者中的59%（P＜0.005）。所有临床诊断患者的观察到的5年生存率为8.4%，而病理确诊患者为0.6%。仅考虑局部局限性疾病时，临床诊断患者的5年生存率为27%，病理确诊患者为4%。鉴于胰腺癌长期生存是罕见事件，这些发现表明，在许多老年患者中，胰腺癌的临床诊断是错误的。这些发现对胰腺癌发病率上升（尤其是在老年人中）的统计以及与未经过病理确诊的胰腺癌老年患者讨论预后具有启示意义。
