Epidemiological surveillance of pancreatic cancer in the North region of the state of Rio Grande do Sul

ABSTRACT

Introduction: Pancreatic neoplasia is considered a serious disease, associated with high mortality rates and late diagnosis. This pathology corresponds in the Brazilian scenario, about 2% of the diagnosed cancers. The main risk factors are: advanced age, male sex, black race, smoking, obesity, diabetes, pancreatitis, excessive alcohol use, as well as genetic syndromes such as non-polypoid hereditary colorectal cancer (HNPCC) and breast and ovary (associated with BRCA2 mutations). Objectives: The objective of this study was to identify the main risk factors and to verify which variables related to diagnosis, treatment and staging were present in cases of pancreatic cancer registered in the São Vicente de Paulo Hospital (HSVP) epidemiological surveillance system for cancer. Methods: A cross-sectional, predominantly descriptive, retrospective study using data from patients with pancreatic cancer at the Hospital São Vicente de Paulo (HSVP) was conducted between 2007 and 2017. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), version 18.0, (SPSS Inc., Chicago, IL, USA). Results: A higher incidence was observed in men (51.2%), the predominant age range was between 66 and 80 years (41.9%), the white color was prevalent (91.7%), (13,3%) were users of alcoholic beverages, (33.9%) were smokers or former smokers, (44.9%) were in stage IV when diagnosed and the predominant life span was between 1 and 10 months (35.7%). Conclusions: The risk factors recommended by the literature, with the exception of the black race, are present in the epidemiological profile traced by the present study. In addition, high mortality and late diagnosis were also evidenced through the stage during the diagnosis and the low survival rate. Thus, the study is relevant for the adoption of future preventive and diagnostic measures.

RESUMO

Introdução: A neoplasia pancreática é considerada uma doença grave, associada a altas taxas de mortalidade e diagnóstico tardio. Essa patologia corresponde, no cenário brasileiro, a cerca de 2% dos cânceres diagnosticados. Os principais fatores de risco são: idade avançada, sexo masculino, raça negra, tabagismo, obesidade, diabetes, pancreatite, uso excessivo de álcool, bem como síndromes genéticas, como câncer colorretal hereditário não polipoide (HNPCC) e de mama e ovário (associados a mutações no BRCA2). Objetivos: O objetivo deste estudo foi identificar os principais fatores de risco e verificar quais variáveis relacionadas ao diagnóstico, tratamento e estadiamento estavam presentes nos casos de câncer de pâncreas registrados no sistema de vigilância epidemiológica do Hospital São Vicente de Paulo (HSVP). Métodos: Foi realizado um estudo retrospectivo transversal, predominantemente descritivo, com dados de pacientes com câncer de pâncreas do Hospital São Vicente de Paulo (HSVP) entre 2007 e 2017. A análise estatística foi realizada usando o Statistical Package for the Social Sciences (SPSS), versão 18.0, (SPSS Inc., Chicago, IL, EUA). Resultados: Observou-se maior incidência nos homens (51,2%), faixa etária predominante entre 66 e 80 anos (41,9%), predominância da cor branca (91,7%), (13,3%) usuários de bebidas alcoólicas, (33,9%) eram fumantes ou ex-fumantes, (44,9%) estavam no estágio IV quando diagnosticados e a expectativa de vida predominante foi entre 1 e 10 meses (35,7%). Conclusões: Os fatores de risco recomendados pela literatura, com exceção da raça negra, estão presentes no perfil epidemiológico traçado pelo presente estudo. Além disso, a alta mortalidade e diagnóstico tardio também foram evidenciados através do estágio durante o diagnóstico e a baixa taxa de sobrevida. Portanto, o estudo é relevante para a adoção de futuras medidas preventivas e de diagnóstico.

Keywords:

Pancreatic neoplasms - Epidemiology - Descriptive - Risk factors - Outcome and process assessment (health care)

Descritores:

Neoplasias pancreáticas - Epidemiologia descritiva - Fatores de risco - Avaliação de resultados e processos (cuidados de saúde)

Publication History

Received: 16 July 2019

Accepted: 25 March 2020

Article published online:
10 June 2020

• REFERENCES

• Instituto Nacional de Câncer (INCA). Câncer de pâncreas [Internet]. Brasília (DF): INCA; 2018. access in 2018 Nov 08 Available from: https://www.inca.gov.br/tipos-de-cancer/cancer-de-pancreas
• McGuigan A, Kelly P, Turkington RC, Jones C, Cole-man HG, McCain S.. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol [Internet] 2018; Nov cited ANO mês Dia 24 (43) 4846-4861 Available from: https://www.wjgnet.com/1007-9327/full/v24/i43/4846.htm
• Soldan M.. Pancreatic cancer screening. Rev Col Bras Cir [Internet] 2017; [Apr cited 2019 Mar 05]; 44 (02) 109-111 Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912017000200109&lng=en&tlng=en
• Olson SH, Kurtz RC.. Epidemiology of pancreatic cancer and the role of family history. J Surg Oncol [Internet] 2012; [May cited 2019 Apr 22]; 107 (01) 1-7 Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/jso.23149
• Gatti R, Pereira MAA, Giannella Neto D.. Síndrome de von Hippel-Lindau. Arq Bras Endocrinol Metabol [Internet] 1999; [Oct cited 2019 Mar 13]; 43 (05) 377-388 Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27301999000500011&lng=pt&tlng=pt
• Hruban RH, Canto MI, Goggins M, Schulick R, Klein AP. Update on familial pancreatic cancer. Adv Surg [Internet] 2010; [Sep cited 2019 Mar 02]; 44 (01) 293-311 Available from: https://www.advancessurgery.com/article/S0065-3411(10)00012-6/fulltext
• Becker AE, Hernandez YG, Frucht H, Lucas AL. Pancreatic ductal adenocarcinoma: risk factors, screening, and early detection. World J Gastroenterol [Internet] 2014; [Aug cited 2019 Apr 27]; 20 (32) 11182-98 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145757
• Permuth-Wey J, Egan KM. Family history is a significant risk factor for pancreatic cancer: results from a systematic review and meta-analysis. Familial Cancer [Internet] 2009; [Sep cited 2019 May 22]; 8 (02) 109-117 Available from: https://link.springer.com/article/10.1007%2Fs10689-008-9214-8
• Wolfgang CL, Herman JM, Laheru DA, Klein AP, Erdek MA, Fishman EK. et al Recent progress in pancreatic cancer. CA: Cancer J Clin [Internet] 2013; [Jul cited 2019 Mar 26]; 63 (05) 318-348 Available from: https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21190
• Castillo CF, Jimenez RE. Epidemiology and nonfamilial risk factors for exocrine pancreatic cancer. UpToDate. . Weblog [Internet]. 2016; [cited 2018 Sep 11]; 1–10. Available from: https://www.uptodate.com/contents/epidemiology-and-nonfamilial-risk-factors-for-exocrine-pancreatic-cancer
• American Cancer Society (ACS). Pancreatic cancer risk factors [Internet]. New. York: ACS;; 2019. access in 2019 Feb 11 Available from: https://www.cancer.org/cancer/pancreatic-cancer/causes-risks-prevention/risk-factors.html
• Arnold LD, Patel AV, Yan Y, Jacobs EJ, Thun MJ, Calle EE. et al Are racial disparities in pancreatic cancer explained by smoking and overweight/obesity?. Cancer Epidemiol Biomarkers Prev [Internet] 2009; [Sep cited 2019 Mar 22]; 18 (09) 2397-2405 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630792/pdf/456162.pdf
• Chabner BA. Manual de oncologia de Harrison. 2nd. Porto Alegre: McGraw-Hill Global Education Holdings;; 2015
• Xiao AY, Tan MLY, Wu LM, Asrani VM, Windsor JA. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol. [Internet] 2016; [Sep cited 2019 May 02]; 1 (01) 45-55 Available from: https://www.thelancet.com/journals/langas/article/PIIS2468-1253(16)30004-8/fulltext
• Goldman L, Schafer AI. Cecil Medicina Interna. 24a . Rio de Janeiro: Elsevier;; 2012
• Ministério da Saúde (BR). Doação de órgãos - Pâncreas [Internet]. Brasília (DF): Ministério da Saúde; 2019. access in 2019 Dec 05 Available from: http://www.saude.gov.br/saude-de-a-z/doacao-de-orgaos/pancreas
• Espindola LMD, Mota A, Gomes EAP, Campos OAM, Schneider IJC. Sobrevida em dois anos de pacientes acometidos por câncer de pâncreas e os fatores associados. Arq Catarin Med [Internet] 2013; [Apr/Jun cited 2019 Mar 15]; 42 (02) 629 Available from: http://www.acm.org.br/revista/pdf/artigos/1230.pdf
• Rawla PR, Sunkara TS, Gaduputic VG. Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol [Internet] 2019; [Feb cited 2019 May 13]; 10 (01) 10-27 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396775/#R26
• Barbosa IR, Santos CA, Souza ELB. Pancreatic cancer in Brazil: mortality trends and projections until 2029. Arq Gastroenterol [Internet] 2018; [Jul/ Sep cited 2019 May 14]; 55 (03) 230-236 Available from: http://www.scielo.br/pdf/ag/v55n3/1678-4219-ag-55-03-230.pdf
• Ilic M, Ilic I. Epidemiology of pancreatic cancer. World J Gastroenterol [Internet] 2016; [Nov cited 2019 May 13]; 22 (44) 9694-9705 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124974/
• Mahdavifar N, Mohammadian M, Ghoncheh M, Salehiniya H. Pancreatic cancer in the world: an epidemiological review. World Cancer Res J [Internet] 2018; [cited 2019 May 14]; 5 (04) e1162-72 Available from: https://www.wcrj.net/wp-content/uploads/sites/5/2018/12/e1162-Pancreatic-cancer-in-the-world-an-epidemiological-review.pdf
• World Health Organization (WHO). . International Agency for Research on Cancer (IARC). The Global Cancer Observatory (GCO) [Internet]. France: IARC; access in 2019 May 13 Available from: http://gco.iarc.fr/
• Kamphues C, Bova R, Schricke D, Hippler-Benscheidt M, Klauschen F, Stenzinger A. et al Postoperative complications deteriorate long-term outcome in pancreatic cancer patients. Ann Surg Oncol [Internet] 2012; [cited 2019 Feb 07]; 19 (03) 856-863 Available from: https://link.springer.com/article/10.1245%2Fs10434-011-2041-4
• Torre GL, Waure C, Specchia M, Nicolotti N, Capizzi S, Bilotta A. et al Does quality of observational studies affect the results of a meta-analysis?. The case of cigarette smoking and pancreatic cancer. Pancreas [Internet] 2009; [Apr cited 2019 Feb 07]; 38 (03) 241-247 Available from: https://insights.ovid.com/pubmed?pmid=19307925
• Lowenfels AB, Maisonneuve P, Whitcomb DC, Lerch MM, DiMagno EP. Cigarette smoking as a risk factor for pancreatic cancer in patients with hereditary pancreatitis. JAMA [Internet] 2001; Jul cited May 2019 286 (02) 169-170 Available from: https://jamanetwork.com/journals/jama/article-abstract/1031415
• Muscat JE, Stellman SD, Hoffmann D, Wynder EL.. Smoking and pancreatic cancer in men and women. Cancer Epidemiol Biomarkers Prev [Internet] 1997; [Jan cited 2019 Mar 03]; 6 (01) 9-15 Available from: http://cebp.aacrjournals.org/content/6/1/15.long
• Shore S, Vimalachandran D, Raraty MGT, Ghaneh P. Cancer in the elderly: pancreatic cancer. Surg Oncol [Internet] 2004; [Dec cited 2019 Mar 08]; 13 (04) 201-210 Available from: https://www.sciencedirect.com/science/article/pii/S0960740404000659
• Lillemoe KD, Yeo CJ, Cameron JL. Pancreatic cancer: state-of-the-art care. CA:Cancer J Clin [Internet] 2008; [Dec cited 2019 Feb 22]; 50 (04) 241-268 Available from: https://onlinelibrary.wiley.com/doi/full/10.3322/canjclin.50.4.241?sid=nlm%3Apubmed
• Zhang L, Sanagapalli S, Stoita A. Challenges in diagnosis of pancreatic cancer. World J Gastroenterol [Internet] 2018; [May cited 2019 Mar 14]; 24 (19) 2047-2060 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960811
• Rohde L, Osvaldt AB. Rotinas em cirurgia digestiva. 3rd. Porto Alegre: Artmed;; 2018
• Chu LC, Goggins MG, Fishman EK. Diagnosis and detection of pancreatic cancer. Cancer J [Internet] 2017; [Oct cited 2019 Mar 18]; 23 (06) 333-342 Available from: https://europepmc.org/abstract/med/29189329
• Scarà S, Bottoni P, Scatena R. CA 19-9: biochemical and clinical aspects. In: Scatena R. , ed. Advances in Cancer Biomarkers. Advances in Experimental Medicine and Biology. Dordrecht: Springer [Internet]; 2015. [cited 2019 May 03];867(1): 247-260 Available from: https://link.springer.com/chapter/10.1007%2F978-94-017-7215-0_15
• Zhang Q, Zeng L, Chen Y, Lian G, Qian C, Chen S. et al Pancreatic cancer epidemiology, detection, and management. Gastroenterol Res Pract [Internet] 2016; [Jan cited 2019 Mar 22]; 2016 (01) 8962321 Available from: https://www.hindawi.com/journals/grp/2016/8962321/