Pancreatic cancer - Spontaneous Remission Database

Pancreatic cancer

Epidemiology:

Pancreatic cancer is a formidable malignancy with an incidence rate of approximately 13.5 cases per 100,000 individuals annually in the United States, making it one of the most aggressive cancers worldwide ¹. Despite extensive research and advances in therapeutic interventions, spontaneous remission (SR) from this disease is exceptionally rare, occurring in less than 1% of patients diagnosed with malignant pancreatic neoplasms ¹. Documented cases of SR are typically characterized by unexpected and profound improvements in symptoms or tumor burden, further complicating the accurate assessment of their prevalence and mechanisms ². As a consequence, the identification of SR in pancreatic cancer remains a challenge, as such cases often surface unpredictably and defy conventional prognostic expectations ¹.

Clinical Characteristics:

To date, there have been twelve reported cases of spontaneous regression (SR) involving primary or metastatic pancreatic tumors. Several clinical patterns have been observed among these cases. The patients’ ages at the time of regression ranged from 13 to 77 years, with a predominance observed in males (2:1 ratio). The duration of follow-up ranged from 6 weeks to 13 years. See Table 1 below for further information

Histological Characteristics:

Of the cases analyzed, the histology of the tumors was primarily reported as originating from the pancreas, with most identified as solid or cystic pancreatic lesions. Instances of non-pancreatic malignancies, including extrapancreatic or unrelated tumor types, were excluded from this data collection to ensure diagnostic consistency.

Proposed Contributing Mechanisms:

Among the reported cases, proposed mechanisms varied considerably. Several reports attributed regression to immune or inflammatory responses, hormonal influences, or degenerative changes within the tumor, while others described spontaneous resolution without identifiable contributing factors. A few cases emphasized the role of host immune regulation in mediating tumor regression. The remaining reports did not specify any therapeutic or mechanistic associations. Collectively, these findings suggest that immune activity, hormonal modulation, and degenerative processes may contribute to the spontaneous regression of pancreatic tumors.

Site and Extent of Remission:

The majority of documented cases exhibited complete regression of the primary pancreatic lesion, whereas several others demonstrated remission at metastatic sites such as the liver and lymph nodes. One patient-maintained remission for over a decade, indicating durable disease control. Although follow-up data are limited, these findings suggest that spontaneous regression in pancreatic tumors can occasionally result in sustained remission.

Table 1: Pancreatic cancer SR Cases and Clinical Characteristics

Author–year	Age/sex	Primary site	Remission site	Proposed mechanisms	Follow-up
Melnyk et al., 1965³	50/M	Pancreas	Pancreas	Not reported	20 months
Shapiro, 1967⁴	Not reported	Pancreas	Pancreas	Spiritual healing	7.5 years
Tchertkoff et al., 1974⁵	21/M	Pancreas	Not reported	Immune response	1 year
Nakahara et al., 2008⁶	18/F	Pancreas	Pancreas	Degenerative change	10 years
Suzuki et al., 2010⁷	13/M	Pancreas	Pancreas	Degenerative change	6 weeks
Nakata et al., 2012⁸	51/F	Pancreas	Pancreas	Not reported	Not reported
Yoon et al., 2012⁹	14/M	Pancreas	Liver	Spontaneous regression	13 years
Chin et al., 2018¹⁰	77/M	Pancreas	Pancreas	Not reported	4 months
Ibrahimi et al., 2019¹¹	59/F	Pancreas	Lymph nodes	Inflammatory response	1 year
Saade et al., 2019¹²	56/F	Pancreas	Liver	Immune response	33 months
Yasuda et al., 2023¹³	48/F	Pancreas	Pancreas	Hormonal factors	3 years
Sano, 2017¹⁴	30-year-old woman	bile duct	CT after 1 month revealed spontaneous regression of the mass (24 × 13 mm in size) in the perihilar bile duct which is also apparent on ERCP	central necrosis	CT after 1 month revealed spontaneous regression of the mass (24 × 13 mm in size) in the perihilar bile duct which is also apparent on ERCP
Li, 2022¹⁵	42-year-old female	liver	At 20 months follow-up, enhanced CT of the abdomen showed shrinkage and disappearance of the liver metastases	Spontaneous regression of the hepatic metastases may be attributed to primary tumor resection tipping the immune-mediated balance towards the host, enabling or stimulating the immune system to control residual disease	At 20 months follow-up, enhanced CT of the abdomen showed shrinkage and disappearance of the liver metastases
Matsubayashi, 2019¹⁶	82-year-old Japanese female. history of hypertension	pancreas	Ten days after FNAB the pancreatic lesion seemed to have shrunk to 2.5 cm in size. A subsequent CT, conducted one month after the FNAB, revealed further minimization of the pancreatic mass	None reported	Ten days after FNAB the pancreatic lesion seemed to have shrunk to 2.5 cm in size. A subsequent CT, conducted one month after the FNAB, revealed further minimization of the pancreatic mass
Matsubayashi, 2019¹⁶	82-year-old Japanese female. history of hypertension	pancreas	Ten days after FNAB, positron emission tomography showed that the pancreatic lesion seemed to have shrunk to 2.5 cm in size. The images obtained in the next two months showed that the tumor had almost vanished	None reported	Ten days after FNAB, positron emission tomography showed that the pancreatic lesion seemed to have shrunk to 2.5 cm in size. The images obtained in the next two months showed that the tumor had almost vanished
Herreros-Villanueva et al.¹⁷
Ozden et al., 2005¹⁸
Huang et al.¹⁹
Trajkovic‐Arsic et al.²⁰

References:

Huang J., Lok V., Ngai C., et al. Worldwide burden of, risk factors for, and trends in pancreatic cancer. Gastroenterology. 2021;160(3):744-754. doi:10.1053/j.gastro.2020.10.007
Trajkovic‐Arsic M., Kalideris E., & Siveke J. The role of insulin and igf system in pancreatic cancer. Journal of Molecular Endocrinology. 2013;50(3):R67-R74. doi:10.1530/jme-12-0259
Melnyk CS, Krippaehne WW, Benson JA Jr, Dunphy JE. Spontaneous remission of Zollinger-Ellison syndrome. Arch Intern Med. 1965;115:42-47.
Shapiro SL. Spontaneous regression of cancer. Eye Ear Nose Throat Mon. 1967;46(10):1306-1310.
Tchertkoff V, Hauser AD. Carcinoma of head of pancreas with spontaneous regression. N Y State J Med. 1974;74(10):1814.
Nakahara K, Kobayashi G, Fujita N, et al. Solid-pseudopapillary tumor of the pancreas showing a remarkable reduction in size over the 10-year follow-up period. Intern Med. 2008;47(14):1335-1339. doi:10.2169/internalmedicine.47.0767
Suzuki M, Shimizu T, Minowa K, Ikuse T, Baba Y, Ohtsuka Y. Spontaneous shrinkage of a solid pseudopapillary tumor of the pancreas: CT findings. Pediatr Int. 2010;52(2):335-336. doi:10.1111/j.1442-200X.2010.03039.x
Nakata B, Amano R, Matsuoka J, et al. Spontaneously complete regression of pseudolymphoma of the remnant pancreas after pancreaticoduodenectomy. Pancreatology. 2012;12(3):215-218. doi:10.1016/j.pan.2012.02.011
Yoon HJ, Lim JH. Solid pseudopapillary tumor of the pancreas with hepatic metastasis: spontaneous regression over 10-year follow-up period. Korean J Radiol. 2012;13(5):648-651. doi:10.3348/kjr.2012.13.5.648
Chin KM, Chan CY, Lee SY. Spontaneous regression of pancreatic cancer: a case report and literature review. Int J Surg Case Rep. 2018;42:55-59. doi:10.1016/j.ijscr.2017.11.056
Ibrahimi S, Mukherjee S, Alhyari L, Rubin E, Aljumaily R. Spontaneous regression of metastatic pancreatic cancer: a role for recurrent inflammation. Pancreas. 2019;48(1):e4-e6. doi:10.1097/MPA.0000000000001193
Saade Lemus P, Anderson K, Smith M, Bullock A. Spontaneous regression of pancreatic cancer with liver metastases. BMJ Case Rep. 2019;12(5):e229619. doi:10.1136/bcr-2019-229619
Yasuda H, Kataoka K, Miyake H, Sogame Y, Sakagami J, Yasukawa S, Konishi E, Yanagisawa A, Itoh Y. Spontaneous regression in solid pseudopapillary neoplasm of pancreas. Clin J Gastroenterol. 2023;16(1):105-109. doi:10.1007/s12328-022-01715-4
Sano, I., Kuwatani, M., Sugiura, R., Kato, S., Kawakubo, K., Ueno, T., Nakanishi, Y., Mitsuhashi, T., Hirata, H., Haba, S., Hirano, S., & Sakamoto, N. (2017). Hepatobiliary and Pancreatic: A rare case of a well-differentiated neuroendocrine tumor in the bile duct with spontaneous regression diagnosed by EUS-FNA. Journal of gastroenterology and hepatology, 32(1), 11. https://doi.org/10.1111/jgh.13585
Li, X., & Liu, Y. (2022). Spontaneous regression of solid-pseudopapillary neoplasms with hepatic metastases. Hepatobiliary surgery and nutrition, 11(1), 169–170. https://doi.org/10.21037/hbsn-21-438
Matsubayashi, H., Uesaka, K., Sasaki, K., Shimada, S., Takada, K., Ishiwatari, H., & Ono, H. (2019). A Pancreatic Inflammatory Myofibroblastic Tumor with Spontaneous Remission: A Case Report with a Literature Review. Diagnostics (Basel, Switzerland), 9(4), 150. https://doi.org/10.3390/diagnostics9040150
Herreros-Villanueva, M., Hijona, E., Cosme, A., & Bujanda, L.. Spontaneous regression of pancreatic cancer: Real or a misdiagnosis?
Ozden, I., Dizdaroglu, F., Poyanli, A., & Emre, A. (2005). Spontaneous regression of a pancreatic head mass and biliary obstruction due to autoimmune pancreatitis. Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ...[Et Al.], 5(2-3), 300-303. doi:10.1159/000085287
Huang J., Lok V., Ngai C., et al. Worldwide burden of, risk factors for, and trends in pancreatic cancer
Trajkovic‐Arsic M., Kalideris E., & Siveke J. The role of insulin and igf system in pancreatic cancer. Journal of Molecular Endocrinology. 2013;50(3):R67-R74

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