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In Finland, pancreatic cancer constitutes approximately 3% of all diagnosed cancers. However, it is the third and fourth most common cause of cancer death in females and males, respectively ( www.cancerregistry.fi ). More than 90% of pancreatic cancers are ductal adenocarcinomas (PDAC), which are known for their extremely poor prognosis, whereas other types of pancreatic malignant tumours may have a more favourable prognosis. In many studies involving extensive surgery, the prognosis did not seem to be substantially influenced or improved. 1- 6 The reported values on long time survivors of PDAC have been questioned and it has been claimed that they are markedly lower than reported. While five year survival rates of 30-55% in PDAC patients treated with a curative intent have been published, 7- 11 reports of actual five year survival have usually been more modest, (approximately 10-20% for patients undergoing curative resection). 12- 16 Some series have failed to report any five year survivors 17- 19 and many authors believe that the actual values are close to zero. 20- 22
In order to obtain reliable non-biased data, we performed a nationwide study which included all Finnish patients diagnosed with pancreatic cancer (ICD = C25) in 1990-1996 that had survived for at least five years after diagnosis.
PATIENTS AND METHODS
The Finnish Cancer Registry is a countrywide population based (population 5.1 million) register that collects data on all cancer cases in Finland. All hospitals and pathology and haematology laboratories as well as dentists submit mandatory data on cancer patients to the cancer registry. Additional data on survival and cause of death were obtained from Statistics Finland. The files were searched for patients diagnosed with pancreatic cancer (ICD = C25) from 1990 to 1996 who survived for more than five years. All slides or paraffin blocks (except for two cases) from patients recorded as having histologically proven PDAC were collected and re-evaluated in a double blind fashion by three pathologists with special expertise in pancreatic pathology (SN, Helsinki University Central Hospital, Finland; and JL and GK, University of Kiel, Germany).
RESULTS
According to the Finnish Cancer Registry, 4922 patients (2170 males) were diagnosed with pancreatic cancer (ICD = C25) from 1990 to 1996. Eighty nine patients (1.8%) were recorded as having survived for at...