Analysis of various clinical and pathological factors affecting survival in patients diagnosed with pancreatic adenocarcinoma: Single institute study
Authors: A. Nagy
Journal: Annals of Oncology (2018)

Introduction: Worldwide, pancreatic cancer ranks 13th in incidence but is the 8th cause of cancer related death. Unfortunately even with early diagnosis, mortality rates are high. The collective median overall survival for all patients ranges from 4-6 months. The initial symptoms of the disease are often vague and nonspecific abdominal pain and weight loss which are subtle in onset and most patients present in an advanced stage. Methods: This is a retrospective study aiming at evaluating the clinic-epidemiological and pathological factors affecting overall survival (OS) in patients diagnosed with pathologically proven pancreatic adenocarcinoma and received treatment at Ain Shams University Department of Clinical Oncology in the period from 1-1-2008 till 1-1-2012. Data collected from files of patients included age, gender, residence, smoking status, medical history of viral hepatitis, family history of cancer, clinical presentation, total bilirubin at presentation, stage, pathology, grade, offered treatment and overall survival (OS). The collected data was revised, coded, tabulated and introduced to PC using statistical package for social science (SPSS 20.0 for windows; SPSS Inc, Chicago, IL, 2001). Numerical data were summarized as means and standard deviations (SD) or medians and ranges as appropriate. While qualitative data were described as frequencies and percentages. The Chi square test was used for comparisons of the categorical variables. Overall survival estimates were calculated using Kaplan-Meier method. Overall Survival (OS) was calculated from the time of diagnosis to date of death or last follow up. Results: The study included 109 patients (Males 83.5%) where the median age was 58 years (±6.522, range 45-68) and the majority of the patients were of urban residence (74.3%) and most were smokers (71.6%). Positive family history of cancer was reported in about 20% of the studied patients and the most common presentation was jaundice (48.6%). The median overall survival (OS) was 7.5 months (±3.721, range 3-17). The OS was statistically significantly higher in non-smokers 15 months (95% CI 10.627-19.373) versus 7.5 (95% CI 6.973-8.027) months in smokers (p<.0001). Patients who presented with total bilirubin more than 10 mg/dL had a OS of 5 months (95% CI4.253-5.747) which was statistically lower than other patients(p<.0001). The presence of viral hepatitis (HBV and HCV) had a negative effect on survival where positive patients had a 5 month OS (95%CI 4.433-5.567) versus 9 months (95%CI 8.458-9.542) in viral hepatitis free patients (p<.0001). Other factors which significantly affected survival negatively were metastatic presentation (6.9 months, 95%CI 5.906-7.894) and grade 3 pathology (5 months, 95%CI 3.852-6.148). The other observed variables were not associated with a statistically significant effect on survival. Conclusion: Pancreatic carcinoma still poses a significant clinical challenge, however the eradication of certain predisposing factors like smoking and viral hepatitis could greatly affect the outcome of treatment.