The prognostic role of time to diagnosis and presenting symptoms in patients with pancreatic cancer

Gobbi, Paolo G.; Bergonzi, M.; Comelli, Mario; Villano, Lara; Pozzoli, Donatella; Vanoli, Alessandro; Dionigi, Paolo

doi:10.1016/j.canep.2012.12.002

Cited by 77 publications

(64 citation statements)

References 19 publications

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“…There have only been three previous studies that have investigated a component of the diagnostic interval and patient outcomes in PDAC. Two of these studies identified a positive association between shorter intervals and improved patient outcomes (13,14), and one found no association (15). Gobbi et al (13) found a positive association between the “time to diagnosis” (symptom onset–diagnosis) and survival and Raptis et al (14) found a shorter “pre-hospital” delay (symptom onset–referral to a specialist) to be positively associated with survival.…”

Section: Discussionmentioning

confidence: 99%

“…Two of these studies identified a positive association between shorter intervals and improved patient outcomes (13,14), and one found no association (15). Gobbi et al (13) found a positive association between the “time to diagnosis” (symptom onset–diagnosis) and survival and Raptis et al (14) found a shorter “pre-hospital” delay (symptom onset–referral to a specialist) to be positively associated with survival. McLean et al (15) found no association between “wait times” (symptoms–surgical consultation and surgical consultation–procedure) on resectability or survival.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic intervals and pancreatic ductal adenocarcinoma (PDAC) resectability: a single-center retrospective analysis

Deshwar¹,

Sugar²,

Torto³

et al. 2018

Ann Pancreat Cancer

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Background Pancreatic ductal adenocarcinoma (PDAC) often presents with nonspecific symptoms and the workup is not standardized. To study the impact of delays in diagnosis and in the initiation of treatment, we investigated the relationship between length of diagnostic intervals and surgical resectability. Methods We performed a retrospective chart review of patients evaluated for PDAC at Johns Hopkins in 2014. Data were collected on the patient (date of first symptoms—first medical appointment), diagnostic (first medical appointment—diagnosis of PDAC), and treatment (diagnosis of PDAC—1st day of treatment) time intervals, and the upfront treatment received. Asymptomatic patients diagnosed incidentally, or for whom records were incomplete, were excluded from analysis. Results Of 453 charts reviewed, 116 patients met inclusion criteria. The median patient interval was 14 days [interquartile range (IQR): 6–30 days], the median diagnostic interval was 22 days (IQR: 8–46 days), and the median treatment interval was 26 days (IQR: 15–35 days). Thirty-eight patients (33%) received upfront surgery and 78 (67%) received nonsurgical treatment. After adjusting for multiple factors, the odds of receiving surgery significantly increased for individuals with a patient interval of 30 days or less [adjusted odds ratio (aOR): 3.41; 95% confidence interval (CI): 1.08–13.20; P=0.050] and with a diagnostic interval of 60 days or less (aOR: 15.68; 95% CI: 2.95–291.00, P=0.009). Conclusions A patient interval less than 1 month and a diagnostic interval less than 2 months for symptomatic PDAC are associated with increased odds of upfront surgical resection. These data provide initial evidence that reducing diagnostic delays may lead to improved outcomes in PDAC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic intervals and pancreatic ductal adenocarcinoma (PDAC) resectability: a single-center retrospective analysis

Deshwar¹,

Sugar²,

Torto³

et al. 2018

Ann Pancreat Cancer

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“…Patients with pancreatic cancer may be relatively asymptomatic during its early course, with vague presenting symptoms such as back and epigastric pain. 16,17 Until the systemic symptoms of weight loss, anorexia and obstructive jaundice appear, it can be a difficult diagnosis to achieve. The role of imaging in such patients is to identify a pancreatic lesion, determine its malignant potential and assess its resectability.…”

Section: Standard Diagnostic Practicementioning

confidence: 99%

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

Ghaneh

Hanson

Titman

et al. 2018

Health Technol Assess

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Background Pancreatic cancer diagnosis and staging can be difficult in 10–20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. Objective To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. Design A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. Participants Patients with suspected pancreatic malignancy. Interventions All patients to undergo PET/CT following standard diagnostic work-up. Main outcome measures The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients’ diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. Results Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUVmax.) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity (p = 0.01) and specificity (p = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios (p < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients (p = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval –0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. Conclusion PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. Study registration Current Controlled Trials ISRCTN73852054 and UKCRN 8166. Funding The National Institute for Health Research Health Technology Assessment programme.

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“…Cancer-specific signs and symptoms (as jaundice, Courvoisier's sign, back pain, and weight loss) are associated with advanced PC (stages III and IV disease); these predict early death as PC progresses rapidly once symptomatic; PC is diagnosed a median of 2 months after the onset of symptoms [3], and death occurs 4-6 months following diagnosis. Delay to diagnosis is a significant independent prognostic factor for survival when stage is accounted for in multivariable analysis [4]. Because symptoms occur late in the course of the disease, detection of resectable PC will require screening asymptomatic subjects.…”

mentioning

confidence: 99%

Why is pancreatic adenocarcinoma not screened for earlier?

Maroni

Ravaioli

Pinna

2016

Expert Review of Anticancer Therapy

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The prognostic role of time to diagnosis and presenting symptoms in patients with pancreatic cancer

Cited by 77 publications

References 19 publications

Diagnostic intervals and pancreatic ductal adenocarcinoma (PDAC) resectability: a single-center retrospective analysis

Diagnostic intervals and pancreatic ductal adenocarcinoma (PDAC) resectability: a single-center retrospective analysis

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

Why is pancreatic adenocarcinoma not screened for earlier?

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