Prognosis of Pancreatic Cancer in Hamadan, Iran (2008-2018): A case Series Study

Background: The present study aimed to determine the prognosis of pancreatic cancer from 21 2008 to 2018 in Hamadan, Iran. A case series study was conducted retrospectively at 22 Beheshti Hospital in Hamadan, Iran. Methods: A total of 409 cases that had been diagnosed with pancreatic cancer from 2008 to 2018 were assessed. The variables included age, gender, pathological type, location involved, early symptoms, metastasis, prognosis and treatments, was extracted from the files and recorded in checklist. Data were analyzed by using SPSS/20 software. Results: The mean of age was 66.23 ± 13.06 year. The most frequent of pancreatic cancers was Adenocarcinomas (66.7%). The highest frequency of early symptoms was jaundice (53.1%) and weight loss (12.7%). The highest frequency of pancreatic cancer lesions was more in the head of pancreas (68.7%). Most patients had metastasis at the beginning of diagnosis (82.3%). Most metastases were in liver (31.5%) and peritoneum (25.2%). The prognosis of the pancreatic cancer is significantly related to the lesion location and the consumption of alcohol, cigare ttes and substance abuse (p <0.05), but it wasn’t correlated with age, sex and pathological type (p> 0.05). The 1-year and 5-year survival rates were 35 (22.3%) and (9.5%), respectively. The lowest and the highest in 5-year survival rate were 36 (7.8%) and (18.8%) in adenocarcinoma and carcinoma type. Conclusion: More preventive considerations were found to be beneficial among this 38 population.


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Pancreatic cancer is the seventh leading cause of cancer-related deaths. Worldwide out of 45 458,918 pancreatic cancer patients and 432,242 related deaths were presented in 2018. As 46 oppose to other cancers, the incidence of pancreatic cancer continues to increase, with little 47 improvement in survival rates [1]. Worldwide, pancreatic cancer is the twelfth most common 48 cancer in men, the eleventh most common cancer in women, and the seventh leading cause of 49 cancer-related deaths. The incidence and mortality of pancreatic cancer is associated with 50 increasing age, and men have slightly higher incidence rates than women [2] . The estimated 51 5-year survival rate for pancreatic cancer is less than 5% [3]. In the past decades, pancreatic 52 cancer mortality has been increasing in both genders (for example, in the United States, 53 European countries, Japan and China [3]. Cancer of the pancreas remains one of the most 54 deadly common cancer types: the Mortality/Incidence ratio is 98% [4]. In Accordance with the American Cancer Society, the average lifetime cumulative risk of pancreatic cancer is 56 approximately 1 in 64 [5]. Mortality and incidence of pancreatic cancer is increasing in Iran.

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Pancreatic cancer is more common in men than women. Pancreatic cancer depends largely on 58 the lifestyle. Survival of pancreatic cancer is low in untreated patients [6,7]. In the study of 59 Ahmedlo et al., from 1998 to 2008 reported the average survival time was 15 months, and 1-60 and 5-years survival was 54.5% and 27%, respectively [8]. The results of the another study 61 showed that age over 50, advanced stage of the disease, non-curable forms, and pathologic 62 involved resection margin were associated with a worse survival [8]  77 was adopted to identify "malignant neoplasm of pancreas" in the current study. ICD is the 78 foundation for the identification of health trends and statistics globally, and the international 79 standard for reporting diseases and health conditions. It is the diagnostic classification 80 standard for all clinical and research purposes [12]. Data processing and statistical analysis 81 were performed by using SPSS/20 software and chi-square test. P value < 0.05 was regarded 82 as significant.

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In this case-series study, 409 patients who referred to Beheshti Hospital in Hamadan, Iran 88 from 2008 to 2018 following the diagnosis of pancreatic cancers were included. The mean 89 and standard deviation of the age of the subjects was 66.23±13.06 year. The minimum age of 90 pancreatic cancers was 24 year and the maximum age was 96 year. There was a significant 91 relationship between aging and the incidence of pancreatic cancers (P <0.05).
Based on the results of Chi-square test, most patients had metastasis at the beginning of 104 diagnosis 337 (82.3%). Also, there was no statistically significant relationship between 105 metastasis and types of pancreatic cancers (P> 0.05).

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The prognosis of the pancreatic cancer is significantly related to the lesion location and the 117 consumption of alcohol, cigarettes and substance abuse (p <0.05), but it wasn't correlated 118 with age, sex and pathological type (p> 0.05) ( Table 2).  The 1-year and 5-year survival rates were 91 (22.3%) and 39 (9.5%), respectively. The lowest 123 and the highest in 5-year survival rate were (7.8%) and (18.8%) in adenocarcinoma and 124 carcinoma type, respectively (Table 3). Tobacco, smoking and drinking alcohol are related with an increased risk of pancreatic 143 cancer, which is raised to the incidence of pancreatic cancer [6,14]. Moossavi et al.,have 144 shown that, contrary to smoking, narcotics use is a risk factor for pancreatic cancer and 145 would grow the risk of pancreatic cancer [15]. The present study revealed that prognosis of the pancreatic cancer was significantly related to the lesion location and the consumption of 147 alcohol, cigarettes and substance abuse.  Guigan et al. [17] in a review revealed that the pancreatic cancer was usually given in 160 advanced stages, which makes the 5-year survival of patients about 2% -9% and has a lower 161 prognosis among other cancers. Patients with family risk factors are 9 times more likely to 162 develop this disease [17]. In the present study, the prognosis was low and in 9.5%, which is 163 consistent with the above study. The highest incidence and mortality rates of pancreatic to the identification of the disease in advanced stages [8]. There is no early screening and 174 diagnostic method for this cancer [8,11].

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Limitations: One of the limitations of this study is the existence of files whose information 177 was incomplete and the cases of file defects were completed by telephone. Also, this 178 limitation has been solved by increasing the sample size and studying all the files. This study was performed based on the Helsinki declaration protocol and Good clinical 194 practice guidelines. This study was reviewed and approved by the Ethics Committee of