Pancreatic Cancer: Multicenter Prospective Data Collection and Analysis by the Hungarian Pancreatic Study Group

Abstract

Background & Aims: Pancreatic cancer is a devastating disease with poor prognosis. There is very limited information available regarding the epidemiology and treatment strategies of pancreatic cancer in Central Europe. The purpose of the study was to prospectively collect and analyze data of pancreatic cancer in the Hungarian population.
 Methods: The Hungarian Pancreatic Study Group (HPSG) organized prospective, uniform data collection. Altogether 354 patients were enrolled from 14 Hungarian centers.
 Results: Chronic pancreatitis was present in 3.7% of the cases, while 33.7% of the patients had diabetes. Family history for pancreatic cancer was positive in 4.8%. The most frequent presenting symptoms included pain (63.8%), weight loss (63%) and jaundice (52.5%). The reported frequency of smoking and alcohol consumption was lower than expected (28.5% and 27.4%, respectively). The majority of patients (75.6%) were diagnosed with advanced disease. Most patients (83.6%) had a primary tumor located in the pancreatic head. The histological diagnosis was ductal adenocarcinoma in 90.7% of the cases, while neuroendocrine tumor was present in 5.3%. Biliary stent implantation was performed in 166 patients, 59.2% of them received metal stents. Primary tumor resection was performed in 60 (16.9%) patients. Enteral or biliary bypass was done in 35 and 49 patients, respectively. In a multivariate Cox-regression model, smoking status and presence of gemcitabine-based chemotherapy were identified as independent predictors for overall survival.
 Conclusion: We report the first data from a large cohort of Hungarian pancreatic cancer patients. We identified smoking status and chemotherapy as independent predictors in this cohort.
 Abbreviations: EBM: evidence-based medicine; EPI: exocrine pancreatic insufficiency; FNAB: fine needle aspiration biopsy; HPSG: Hungarian Pancreatic Study Group; MDCT: multi-detector computed tomography; OS: overall survival; PC: pancreatic cancer; RPP: Registry for Pancreatic Patients

Do smoking and alcohol behaviours influence GI cancer survival?

“…Overall, ever smoking was associated with a significant 20% increase risk of death compared to never smoking (n=5 studies [88,89,93,94,96], HR 1.20, 95% CI 1.05, 1.37) with similar findings observed for current smokers compared to never smokers (n=5 studies [90][91][92]95,96], HR 1.19, 95% CI 0.97, 1.46), albeit non-significant. Former smokers experienced a 14% significant increase in mortality risk compared to never smokers (n=5 studies [90][91][92]95,96], HR 1.14, 95% CI 1.01, 1.30) and a marked worse survival was demonstrated in patients who recently quit smoking in the 15 years preceding cancer diagnosis (n=2 studies [92,96], HR 1.42 95% CI 1.16, 1.74).…”

“…We identified nine studies with available risk estimates for inclusion in the review [88][89][90][91][92][93][94][95][96] ( Supplementary table 4). Most studies were conducted in the United States.…”

Retrospective cohort of pancreatic and Vater ampullary adenocarcinoma from a reference center in Mexico

“…Our results are not comparable with international reports. Risch et al (USA group) [ 20 ], Lakatos et al (Hungarian group) [ 21 ], and Ruiz-Tovar et al (Spanish group) [ 21 ] reported 44.7% (42.8%–46.6%) of female patients, with variable mean ages of 68.5 years, 65.2 years and 63.7 years, respectively [ 22 ]. Our cohort presented a higher prevalence of PDAC in females and a slightly younger mean age than other studies ( Table 2 ).…”

“…These results are comparable with a study by Risch et al that found that 69% of patients were smokers and 24.8% were obese with a mean BMI of 27 [ 20 ]. Lakatos et al identified that 28.5% of patients were smokers and 42.3% were overweight or obese [ 21 ], and Ruiz-Tovar found that 37.3% of patients were smokers and 3.4% were obese [ 22 ]. We only identified 28% of patients with type 2 diabetes mellitus, a well-known risk factor for PDAC [ 10 ].…”

Analysis of Research Activity in Gastroenterology: Pancreatitis Is in Real Danger

“…In the USA, not only are 60–70 million people affected by such diseases each year, but they also cause around a quarter million deaths annually and generate an estimated cost of $150 billion per year [ 7 ]. There is no specific therapy for many of these diseases, including pancreatitis and pancreatic cancer [ 10 – 12 ]. Of course, first, the pathomechanisms of the disease should be understood, new therapeutic targets revealed and the biomedical industry attracted [ 13 – 16 ].…”