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Pancreatic Cancer With Malignant Ascites: Clinical Features and Outcomes

Takahara, Naminatsu MD, PhD; Isayama, Hiroyuki MD, PhD; Nakai, Yousuke MD, PhD; Sasaki, Takashi MD, PhD; Saito, Kei MD; Hamada, Tsuyoshi MD, PhD; Mizuno, Suguru MD, PhD; Miyabayashi, Koji MD, PhD; Mohri, Dai MD, PhD; Kogure, Hirofumi MD, PhD; Matsubara, Saburo MD, PhD; Yamamoto, Natsuyo MD, PhD; Hirano, Kenji MD, PhD; Ijichi, Hideaki MD, PhD; Tateishi, Keisuke MD, PhD; Tada, Minoru MD, PhD; Koike, Kazuhiko MD, PhD

doi: 10.1097/MPA.0000000000000290
Original Articles

Objectives Malignant ascites (MA) caused by peritoneal carcinomatosis is not uncommon in patients with pancreatic cancer. However, the clinical features and outcomes in these patients remain to be elucidated.

Methods Baseline characteristics and overall survival (OS) of consecutive patients with advanced pancreatic cancer who presented with MA were retrospectively evaluated.

Results Of 494 patients with advanced pancreatic cancer, 73 (15%) presented with MA. Patients with synchronous MA (n = 21), compared with those with metachronous MA (n = 52), had better performance status (P = 0.02), smaller amount of ascites (P < 0.01), and higher chance of receiving chemotherapy (57% vs 17%, P < 0.01), and resulted in longer OS (115 vs 42 days, P < 0.01). Overall survival was significantly longer in patients receiving chemotherapy than in those with best supportive care alone (124 vs 50 days, P < 0.01). In a multivariate analysis, chemotherapy was prognostic in addition to performance status, CRP, and small amount of MA; the hazard ratio of chemotherapy was 0.46, compared with best supportive care alone (P = 0.02).

Conclusions Although the prognosis of pancreatic cancer patients with MA remains poor, selected patients may be candidate for chemotherapy, regardless of the timing of appearance of MA.

From the Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Received for publication August 6, 2014; accepted December 23, 2014.

Reprints: Hiroyuki Isayama, MD, PhD, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan (e-mail:

The authors declare no conflict of interest.

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