Diagnostic delay does not influence survival of pancreatic cancer patients

被引:17
作者
Stornello, Caterina [1 ]
Archibugi, Livia [1 ,2 ]
Stigliano, Serena [1 ]
Vanella, Giuseppe [1 ]
Graglia, Benedetta [1 ]
Capalbo, Carlo [3 ]
Nigri, Giuseppe [4 ]
Capurso, Gabriele [1 ,2 ]
机构
[1] S Andrea Hosp, Digest & Liver Dis Unit, Rome, Italy
[2] San Raffaele Sci Inst IRCCS, Pancreatobiliary Endoscopy & Endosonog Div, Milan, Italy
[3] S Andrea Hosp, Oncol Unit, Rome, Italy
[4] S Andrea Hosp, Surg Unit, Rome, Italy
关键词
Pancreatic cancer; symptoms; diagnostic delay; risk factors; survival; HIGH-RISK; ADENOCARCINOMA; SURVEILLANCE; INDIVIDUALS; SYMPTOMS;
D O I
10.1177/2050640619879004
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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/m(2). 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.
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页码:81 / 90
页数:10
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