Prognosis of human pancreatic adenocarcinoma: review of clinical and histopathological variables and possible uses of new molecular methods.

Cancer of the exocrine pancreas is a disease of considerable importance in gastroenterology. In Western countries it is the fourth commonest cause of death from cancer after those of lung, colorectal, and breast. The incidence of pancreatic carcinoma has increased in Northern Europe and North America during recent decades and contrary to for example, lung, gastric and oesophageal carcinoma, its incidence is still increasing the annual incidence is about 8-10/100,000 population. The causes of its increased incidence are unknown, as is the aetiology of the disease itself. Pancreatic cancer generally grows without symptoms until late in its natural history and there are therefore many discouraging unresolved problems in management. However, some progress has been made in understanding the molecular basis of pancreatic carcinogenesis. Recent molecular pathological studies have described mutation or overexpression of important oncogenes such as K-ras and bcl-2 and deletions of tumour suppression genes such p53, DPC4, CDKN2, and the Rb gene. The present prognosis of pancreatic cancer is, however, controversial, and as these new markers may have the potential for improving our ability to predict its course, we have reviewed current knowledge, and concentrated on the classic and the recently-introduced factors in the prediction of its prognosis.