BACKGROUND: Most pancreatic ductal adenocarcinoma patients present with advanced disease. Whether it is possible to increase survival by earlier diagnosis is unclear. OBJECTIVE: The purpose of this study was to investigate the association between presenting complaints and risk factors for pancreatic cancer with diagnostic delay, stage and survival. METHODS: This was a single-centre retrospective cohort study. Consecutive patients were interviewed and data on demographics, medical history, risk factors and complaints leading to pancreatic ductal adenocarcinoma diagnosis and disease stage were recorded. Diagnostic delay was considered as time between first complaint and diagnosis. Patients received appropriate treatments and their outcome was recorded in a dedicated database. The Chi-square test for comparison of categorical variables and the Mann-Whitney test for continuous variables were employed with Bonferroni corrections. Correlation between continuous variables was evaluated by means of the Spearman correlation coefficient. Survival analysis was performed with the Kaplan-Meier method and a log-rank test. RESULTS: The median diagnostic delay for 477 pancreatic ductal adenocarcinoma patients was two months (interquartile range 1-5), being significantly shorter for patients presenting with jaundice compared with those with pain, weight loss, diabetes (p < 0.001). The global rate of metastatic disease at diagnosis was 40%, being only 22% in those presenting with jaundice. The median diagnostic delay, however, was not significantly different among disease stages but was significantly longer in patients with a body mass index>25 kg/m2. The median survival time was seven months. Factors associated with worse survival at the multivariable analysis were older age (hazard ratio 1.02 per year), metastatic disease (hazard ratio 2.12) and pain as presenting complaint (hazard ratio 1.32), while diagnostic delay was not. CONCLUSION: While some complaints are associated with a shorter diagnostic delay and less advanced disease stage, we could not demonstrate that delay is associated with survival, possibly suggesting that prevention rather than early recognition is important to tackle pancreatic cancer lethality.
BACKGROUND: Most pancreatic ductal adenocarcinomapatients present with advanced disease. Whether it is possible to increase survival by earlier diagnosis is unclear. OBJECTIVE: The purpose of this study was to investigate the association between presenting complaints and risk factors for pancreatic cancer with diagnostic delay, stage and survival. METHODS: This was a single-centre retrospective cohort study. Consecutive patients were interviewed and data on demographics, medical history, risk factors and complaints leading to pancreatic ductal adenocarcinoma diagnosis and disease stage were recorded. Diagnostic delay was considered as time between first complaint and diagnosis. Patients received appropriate treatments and their outcome was recorded in a dedicated database. The Chi-square test for comparison of categorical variables and the Mann-Whitney test for continuous variables were employed with Bonferroni corrections. Correlation between continuous variables was evaluated by means of the Spearman correlation coefficient. Survival analysis was performed with the Kaplan-Meier method and a log-rank test. RESULTS: The median diagnostic delay for 477 pancreatic ductal adenocarcinomapatients was two months (interquartile range 1-5), being significantly shorter for patients presenting with jaundice compared with those with pain, weight loss, diabetes (p < 0.001). The global rate of metastatic disease at diagnosis was 40%, being only 22% in those presenting with jaundice. The median diagnostic delay, however, was not significantly different among disease stages but was significantly longer in patients with a body mass index>25 kg/m2. The median survival time was seven months. Factors associated with worse survival at the multivariable analysis were older age (hazard ratio 1.02 per year), metastatic disease (hazard ratio 2.12) and pain as presenting complaint (hazard ratio 1.32), while diagnostic delay was not. CONCLUSION: While some complaints are associated with a shorter diagnostic delay and less advanced disease stage, we could not demonstrate that delay is associated with survival, possibly suggesting that prevention rather than early recognition is important to tackle pancreatic cancer lethality.
Authors: Miquel Porta; Xavier Fabregat; Núria Malats; Luisa Guarner; Alfredo Carrato; Ana de Miguel; Laura Ruiz; Manuel Jariod; Sergi Costafreda; Susana Coll; Juan Alguacil; Josep M Corominas; Ricard Solà; Antonio Salas; Francisco X Real Journal: Clin Transl Oncol Date: 2005-06 Impact factor: 3.405
Authors: Manfred P Lutz; John R Zalcberg; Michel Ducreux; Daniela Aust; Marco J Bruno; Markus W Büchler; Jean-Robert Delpero; Beat Gloor; Rob Glynne-Jones; Werner Hartwig; Florence Huguet; Pierre Laurent-Puig; Florian Lordick; Patrick Maisonneuve; Julia Mayerle; Marc Martignoni; John Neoptolemos; Andrew D Rhim; Bruno M Schmied; Thomas Seufferlein; Jens Werner; Jean-Luc van Laethem; Florian Otto Journal: Eur J Cancer Date: 2017-04-29 Impact factor: 9.162
Authors: Lola Rahib; Benjamin D Smith; Rhonda Aizenberg; Allison B Rosenzweig; Julie M Fleshman; Lynn M Matrisian Journal: Cancer Res Date: 2014-06-01 Impact factor: 12.701
Authors: Vanessa L Gordon-Dseagu; Susan S Devesa; Michael Goggins; Rachael Stolzenberg-Solomon Journal: Int J Epidemiol Date: 2018-04-01 Impact factor: 7.196
Authors: Fiona M Walter; Katie Mills; Silvia C Mendonça; Gary A Abel; Bristi Basu; Nick Carroll; Sue Ballard; John Lancaster; William Hamilton; Greg P Rubin; Jon D Emery Journal: Lancet Gastroenterol Hepatol Date: 2016-10-04
Authors: Monica Consolandi; Carlo Martini; Michele Reni; Paolo Giorgio Arcidiacono; Massimo Falconi; Guendalina Graffigna; Gabriele Capurso Journal: Front Med (Lausanne) Date: 2020-04-30