Correlation of biliary stenting with clinical outcome in patients with advanced pancreatic cancer treated with chemotherapy.

Abstract

349 Background: The head of the pancreas is a common location for primary pancreatic tumour and therefore obstructive jaundice is a common complication deriving from this location. Although very important in the palliative treatment of this setting of patients, endoscopic procedures are an important source of complications, frequently influencing the prognosis. Aim of our analysis was to assess the clinical outcome of pancreatic cancer patients with biliary stent. Methods: We retrospectively analyzed a population of metastatic or locally advanced pancreatic cancer patients receiving at our Institution a first line chemotherapy between 2002 and 2010. Results: 163 patients were eligible for our analysis, 29 (18%) carried a biliary stent before first line treatment. A statistically significant difference in time to progression (TTP) was found in patients with or without biliary stent (respectively 2.77 months vs 4.27 months p=0,03). Clinical characteristics were homogeneous between the two groups (age, sex, performance status, stage, objective response rate, chemotherapy performed, toxicity profile). Overall survival analysis was worse in patients with biliary stent (5.93 months vs 8.33 months). In the group of patients with biliary stent toxicity was worse in patients receiving a combination chemoterapy (GEMOX). Conclusions: In our population placement of biliary stent seems to have a negative prognostic role in advanced pancreatic cancer patients. Our data also show that in patients with biliary stent the toxicity profile of chemotherapy may influence treatment adherence and clinical outcome. These observations seem to suggest that patients with obstructive jaundice even when successfully treated with plastic or metal stent may still represent a group of patients with a worse clinical outcome, not suitable for an intensive first-line approach such as FOLFIRINOX.