Pancreatic cancer in England and Wales 1975-2000: patterns and trends in incidence, survival and mortality

Highly accurate diagnosis of pancreatic cancer by integrative modeling using gut microbiome and exposome data

The noninvasive detection of pancreatic ductal adenocarcinoma (PDAC) remains an immense challenge. In this study, we proposed a robust, accurate, and noninvasive classifier, namely Multi-Omics Co-training Graph Convolutional Networks (MOCO-GCN). It achieved high accuracy (0.9 ± 0.06), F1 score (0.9± 0.07), and AUROC (0.89± 0.08), surpassing contemporary approaches. The performance of model was validated on an external cohort of German PDAC patients. Additionally, we discovered that the exposome may impact PDAC development through its complex interplay with gut microbiome by mediation analysis. For example, Fusobacterium hwasookii nucleatum, known for its ability to induce inflammatory responses, may serve as a mediator for the impact of rheumatoid arthritis on PDAC. Overall, our study sheds light on how exposome and microbiome in concert could contribute to PDAC development, and enable PDAC diagnosis with high fidelity and interpretability.

Diagnostic Bioliquid Markers for Pancreatic Cancer: What We Have vs. What We Need

Pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer, currently has a dismal five-year survival rate of approximately 10% due to late diagnosis and a lack of efficient treatment options such as surgery. Furthermore, the majority of PDAC patients have surgically unresectable cancer, meaning cancer cells have either reached the surrounding blood vessels or metastasized to other organs distant from the pancreas area, resulting in low survival rates as compared to other types of cancers. In contrast, the five-year survival rate of surgically resectable PDAC patients is currently 44%. The late diagnosis of PDAC is a result of little or no symptoms in its early stage of development and a lack of specific biomarkers that may be utilized in routine examinations in the clinic. Although healthcare professionals understand the importance of early detection of PDAC, the research on the subject has lagged and no significant changes in the death toll of PDAC patients has been observed. This review is focused on understanding potential biomarkers that may increase the early diagnosis of PDAC patients at its surgically resectable stage. Here, we summarize the currently available biomarkers used in the clinic as well as those being developed with the hope of providing insight into the future of liquid biomarkers to be used in routine examinations for the early diagnosis of PDAC.

Evolving knowledge in surgical oncology of pancreatic cancer: from theory to clinical practice-a fifteen-year journey at a tertiary referral centre

Pancreatic ductal adenocarcinoma (PDAC) is an increasing disease having a poor prognosis. The aim of the present study was to evaluate the effect of different models of care for pancreatic cancer in a tertiary referral centre in the period 2006-2020. Retrospective study of patients with PDAC observed from January 2006 to December 2020. The demographic and clinical data, and data regarding the imaging techniques used, preoperative staging, management, survival and multidisciplinary tumour board (MDTB) evaluation were collected and compared in three different periods characterised by different organisation of pancreatic cancer services: period A (2006-2010); period B (2011-2015) and period C (2016-2020). One thousand four hundred seven patients were analysed: 441(31.3%) in period A; 413 (29.4%) in B and 553 (39.3%) in C. The proportion of patients increased significantly, from 31.3% to 39.3% (P = 0.032). Body mass index (P = 0.033), comorbidity rate (P = 0.002) and Karnofsky performance status (P < 0.001) showed significant differences. Computed tomography scans (P < 0.001), endoscopic ultrasound (P < 0.001), fine needle aspiration, fine needle biopsy (P < 0.001), and fluorodeoxyglucose-positron emission tomography/computed tomography (P < 0.001) increased; contrast-enhanced ultrasound (P = 0.028) decreased. The cTNM was significantly different (P < 0.001). The MDTB evaluation increased significantly (P < 0.001). Up-front surgery and exploratory laparotomy decreased (P < 0.001), neoadjuvant treatment increased (P < 0.001). The present study showed the evolving knowledge in surgical oncology of pancreatic cancer at a tertiary referral centre over the time. The different models of care of pancreatic cancer, in particular the introduction of the MDTB and the institution of a pancreas unit to the decision-making process seemed to be influential.

Non-Cancer Causes of Death in Patients With Pancreatic Adenocarcinoma: A Surveillance, Epidemiology, and End Results (SEER)-Based Study

Background This study aimed to identify the most common causes of non-cancer mortality in patients with pancreatic adenocarcinoma (PAC) and compare their mortality risk with the general population. Methodology This study analyzed PAC patients' data registered in the Surveillance, Epidemiology, and End Results (SEER) database. We studied the causes of death and investigated their association with age, sex, race, tumor stage at presentation, and treatment modality according to the time interval from diagnosis during which death events occurred. We used the standardized mortality ratio (SMR). Results A total of 67,694 PAC patients' data were analyzed; of these patients, 64,347 (95.06%) died during the follow-up. Most deaths occurred due to cancer (61,685; 95.86% of deaths), while non-cancer mortality represented only 4.14%. The most common causes of non-cancer mortality were heart diseases (SMR = 2.79), cerebrovascular diseases (SMR = 3.11), and septicemia (SMR = 8.2). PAC patients had a higher mortality risk for all studied mortality causes except Alzheimer's disease (SMR = 0.5) and homicide and legal intervention (SMR = 2.29). Conclusions Approximately 96% of PAC patients' deaths are due to cancer. While the dominant non-cancer causes of death include heart diseases, cerebrovascular diseases, and septicemia, with a higher risk of mortality for most non-cancer causes than the general population.

Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes

This review aims to outline the most up-to-date knowledge of pancreatic adenocarcinoma risk, diagnostics, treatment and outcomes, while identifying gaps that aim to stimulate further research in this understudied malignancy. Pancreatic adenocarcinoma is a lethal condition with a rising incidence, predicted to become the second leading cause of cancer death in some regions. It often presents at an advanced stage, which contributes to poor five-year survival rates of 2%-9%, ranking firmly last amongst all cancer sites in terms of prognostic outcomes for patients. Better understanding of the risk factors and symptoms associated with this disease is essential to inform both health professionals and the general population of potential preventive and/or early detection measures. The identification of high-risk patients who could benefit from screening to detect pre-malignant conditions such as pancreatic intraepithelial neoplasia, intraductal papillary mucinous neoplasms and mucinous cystic neoplasms is urgently required, however an acceptable screening test has yet to be identified. The management of pancreatic adenocarcinoma is evolving, with the introduction of new surgical techniques and medical therapies such as laparoscopic techniques and neo-adjuvant chemoradiotherapy, however this has only led to modest improvements in outcomes. The identification of novel biomarkers is desirable to move towards a precision medicine era, where pancreatic cancer therapy can be tailored to the individual patient, while unnecessary treatments that have negative consequences on quality of life could be prevented for others. Research efforts must also focus on the development of new agents and delivery systems. Overall, considerable progress is required to reduce the burden associated with pancreatic cancer. Recent, renewed efforts to fund large consortia and research into pancreatic adenocarcinoma are welcomed, but further streams will be necessary to facilitate the momentum needed to bring breakthroughs seen for other cancer sites.

Rising trends in pancreatic cancer incidence and mortality in 2000-2014

Background

The morbidity and mortality of pancreatic cancer vary considerably around the world. The aim of this study was to characterize and evaluate recent changes in incidence and incidence-based mortality in the USA.

Methods

Incidence and incidence-based mortality data were based on the 18 Surveillance, Epidemiology, and End Results (SEER) registries through SEER^*Stat software. We adopted joinpoint regression to analyze the temporal trends stratified by age, gender, ethnicity, stage, tumor site, and size.

Results

Based on 18 SEER data sets, the age-adjusted incidence of pancreatic cancer increased from 11.85/100,000 in 2000 to 14.70/100,000 in 2014, increasing by an average annual percentage change (AAPC) of 1.6 (95% CI 1.5-1.8, p<0.05). The incidence-based mortality also increased, from 9.96/100,000 in 2001 to 12.96/100,000 in 2014, increasing by an AAPC of 1.9 (95% CI 1.3-2.5, p<0.05). However, we observed a deceleration in mortality since 2005, with the annual percentage change decreasing from 4.1 (2001-2005) to 1.0 (2005-2014). These increasing trends in pancreatic cancer were observed in most subgroups (stratified by age, gender, ethnicity, stage, tumor site, and size).

Conclusion

The incidence and mortality rates of pancreatic cancer in the USA have increased significantly since 2000, highlighting the need for increased preventive, screening, and surveillance efforts.

Trends in pancreatic adenocarcinoma incidence and mortality in the United States in the last four decades; a SEER-based study

Background

Pancreatic cancer is the fourth-leading cause of cancer deaths in the United States. The silent nature of the disease and its poor prognosis, the need for further research, along with the need to assess the outcomes of current approaches necessitate an ongoing evaluation of the epidemiology and mortality-trends of this malignancy. Continuous monitoring of disease-patterns, on population-levels, may help scientists assess the quality of healthcare delivery, boost their understanding of diseases' characteristics and risk factors, and detect gaps whereby further research is needed. None of the previous reports shed light on pancreatic adenocarcinomas (PAC), the most common type of Pancreatic Cancer, as the primary outcome. In this study we aim to investigate PAC’s incidence and mortality trends over the last four decades in the United States.

Methods

We used SEER 9 database to study PAC cases during 1974-2014. Incidence and mortality rates were calculated by sex, age, race, state and stage of PAC. Annual percent change (APC) was calculated using joinpoint regression software.

Results

We reviewed 67,878 PAC cases; most of these cases were in the head of pancreas. Overall PAC incidence rates increased 1.03% (95% CI, 0.86-1.21, p <.001) per year over the study period. Rates of adenocarcinoma of the head of pancreas increased 0.87% (95% CI, 0.68-1.07, p <.001), and rates of adenocarcinoma of the body and tail of pancreas increased 3.42% (95% CI, 3.06-3.79, p <.001) per year during 1973-2014. PAC incidence-based mortality increased 2.22% (95% CI, 1.93-2.51, p <.001) per year. However, during 2012-2014 there was a statistically significant decrease in PAC incidence-based mortality; APC, -24.70% (95% CI, -31.78 - -16.88, p <.001).

Conclusion

PAC’s incidence and mortality rates have been increasing for decades. However, the last few years have shown a promising decrease in mortality. We believe that further advances in healthcare delivery and research can lead to a further mortality decrease. Future studies can use this paper as a baseline to keep monitoring the outcomes of PAC's therapy.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4610-4) contains supplementary material, which is available to authorized users.

Incidence of pancreatic cancer in Denmark: 70 years of registration, 1943-2012

BACKGROUND

The aim of this study was to monitor the evolution of the incidence of pancreatic cancer in Denmark over 70 years. We also compared registrations of pancreatic cancer in a nationwide population-based database, the Danish Cancer Registry, and a clinical database, the Danish Pancreatic Cancer Database, in 2012-2013.

MATERIAL AND METHODS

Registrations of pancreatic cancer from the Danish Cancer Registry over 1943-2012 were used to calculate age-specific incidence rates per 100 000 person years by sex and age in 5-year period, weighted by the Segi World Standard Population for age standardization. We used absolute numbers from the Cancer Registry and the Pancreatic Cancer Database, including distribution of topography of cancers registered in 2012-2013, to compare registration in the two data sources.

RESULTS

The incidence rates of pancreatic cancer among Danish men increased until 1968-1972, when a decrease was observed until the mid-1990s. A similar peak was observed in women a decade later but generally at lower incidence. After the mid-1990s, the incidence rates for both sexes increased until the end of the study period. In our comparison of registrations in the Cancer Registry and the Pancreatic Cancer Database in 2012-2013, we found that 29% of the incident cases registered in the Cancer Registry were not in the Database; and 11% of the incident cases registered in the Database, were not registered in the Cancer Registry.

CONCLUSIONS

The incidence of pancreatic cancer increased steadily during the last 20 years of our study period in both sexes. The differences in registration of incident cases in the Cancer Registry and in the Pancreatic Cancer Database indicate underreporting of incident cases of pancreatic cancer in Denmark. The magnitude of this underreporting cannot be estimated based on this data.

Portal vein/superior mesenteric vein resection in pancreatic cancer treatment in the elderly

There is an increased interest in extending surgical criteria for pancreatic cancer by performing pancreaticoduodenectomy (PD) combined with portal vein (PV) or superior mesenteric vein (SMV) resection and reconstruction for borderline resectable patients. However, whether this procedure suitable for elderly patients remains unclear. Here, we studied cases of pancreatic cancer treatment in our medical center to evaluate feasibility and safety of this procedure in the elderly.Eighty-three patients 65 years of age or older who underwent PD from January 2009 to March 2014 were divided into 2 groups: PD only (Group A, 52 cases), and PD combined with PV/SMV resection and reconstruction (Group B, 31 cases). Surgical outcomes and survival rates were compared between groups. Information regarding preoperative, intraoperative and postoperative conditions, and follow-up visits were provided. The outcomes of postoperative complications and survival rates were investigated.No difference in the preoperative data was detected between 2 groups with the exception that the serum albumin level was significantly lower in Group B (P = .013), indicating more deteriorating health conditions in this group. Although intraoperative time and blood loss were higher in Group B (P < .001 and P = .048, respectively), the overall postoperative complications and survival curve showed no statistical differences between 2 groups with one exception in that there was higher incidence of intractable diarrhea in Group B (P = .034). The symptoms, however, resolved later on with conservative treatment. The median survival time for patients in this study was comparable to other reported PD treatments. There was zero postoperative mortality in both groups.PD combined with PV/SMV treatment did not lead to increased morbidity and motility in elderly patients 65 years of age and above. This procedure could provide a promising opportunity for borderline resectable elderly pancreatic cancer patients.

Incidence and mortality of pancreatic cancer on a rapid rise in Taiwan, 1999-2012

BACKGROUND

Accumulating data has revealed a rapidly rising incidence of pancreatic cancer in Western countries, but convincing evidence from the East remains sparse. We aimed to quantify how the incidence and mortality rates of pancreatic malignancy changed over time in Taiwan, and to develop future projection for the next decade.

METHODS

This nationwide population-based study analyzed the Taiwan National Cancer Registry and the National Cause of Death Registry to calculate the annual incidence and mortality rates of pancreatic malignancy from 1999 to 2012 in this country. The secular trend of the incidence was also examined by data from the National Health Insurance Research Database.

RESULTS

A total of 21,986 incident cases of pancreatic cancer and 20,720 related deaths occurred during the study period. The age-standardized incidence rate increased from 3.7 per 100,000 in 1999 to 5.0 per 100,000 in 2012, with a significant rising trend (P<0.01). The increase was nationwide, consistently across subgroups stratified by age, gender, geographic region, and urbanization. Data from the National Health Insurance Research Database corroborated the rise of incident pancreatic cancer. Mortality also increased with time, with the age-standardized rate rising from 3.5 per 100,000 in 1999 to 4.1 per 100,000 in 2012 (P<0.01). In accordance with the incidence, the mortality trend was consistent in all subgroups. Both the incidence and mortality were projected to further increase by approximately 20% from 2012 to 2027.

CONCLUSION

The incidence and mortality of pancreatic cancer have been rapidly rising and presumably will continue to rise in Taiwan.

Predictive global trends in the incidence and mortality of pancreatic cancer based on geographic location, socio-economic status, and demographic shift

BACKGROUND AND OBJECTIVES

Pancreatic Cancer (PC) is a lethal malignancy that accounts for about 4% of cancer-related deaths worldwide. The aim of this study is to describe the influence of geography (based on WHO regions), socio-economic development (based on Human Development Index [HDI]) and demographic shift on the temporal trends in global incidence and mortality of PC.

METHODS

Data (2012-2030) relating to the incidence, mortality of PC and demographic shifts based on WHO regions and HDI areas were extracted from GLOBOCAN 2012. Linear regression was used to evaluate trends in total incidence and mortality.

RESULTS

We noted a definite association between PC and higher socio-economic status. Advanced age (age ≥65) contributed to the rising burden in all socio-economic regions of the world except in the Low Human Development (LHD) countries where the disease predominantly affected population <65 years of age.

CONCLUSIONS

The global burden of PC is expected to rise significantly over the next few decades regardless of geographic location, socio-economic development, age and gender. Advance knowledge of this data can help formulate strategies to specifically target countries and populations that promote public health policy to tackle this lethal disease on the global stage. J. Surg. Oncol. 2016;114:736-742. © 2016 Wiley Periodicals, Inc.

A Systematic Review of the Burden of Pancreatic Cancer in Europe: Real-World Impact on Survival, Quality of Life and Costs

PURPOSE

The purpose of this study was to assess the overall burden of pancreatic cancer in Europe, with a focus on survival time in a real-world setting, and the overall healthy life lost to the disease.

METHODS

Real-world data were retrieved from peer-reviewed, observational studies identified by an electronic search. We performed two de novo analyses: a proportional shortfall analysis to quantify the proportion of healthy life lost to pancreatic cancer and an estimation of the aggregate life-years lost annually in Europe.

RESULTS

Ninety-one studies were included. The median, age-standardised incidence of pancreatic cancer per 100,000 was 7.6 in men and 4.9 in women. Overall median survival from diagnosis was 4.6 months; median survival was 2.8-5.7 months in patients with metastatic disease. The proportional shortfall analysis showed that pancreatic cancer results in a 98 % loss of healthy life, with a life expectancy at diagnosis of 4.6 months compared to 15.1 years for an age-matched healthy population. Annually, 610,000-915,000 quality-adjusted life-years (QALYs) are lost to pancreatic cancer in Europe. Patients had significantly lower scores on validated health-related quality of life instruments versus population norms.

CONCLUSIONS

To the best of our knowledge, this is the first study to systematically review real-world overall survival and patient outcomes of pancreatic cancer patients in Europe outside the context of clinical trials. Our findings confirm the poor prognosis and short survival reported by national studies. Pancreatic cancer is a substantial burden in Europe, with nearly a million aggregate life-years lost annually and almost complete loss of healthy life in affected individuals.

Pancreatic cancer in an Asian population

BACKGROUND AND OBJECTIVES

Most of the available data on pancreatic cancer are from Western countries. The aim was to characterize pancreatic cancer in Asian patients and to compare it with pancreatic cancer in Caucasians.

MATERIALS AND METHODS

Inpatients with histologically proven pancreatic cancer were retrospectively recruited at King Chulalongkorn Memorial Hospital from January 2005 to December 2011.

RESULTS

The study enrolled 100 patients (male:female = 55:45, mean age 62.7 ± 12.9 years). The amount of time between symptom onset and disease diagnosis was 59.89 ± 63.12 days. The common presenting symptoms included abdominal pain or discomfort (71%), weight loss (70%), and jaundice (60%). Fifty-three of the 100 patients had stage 4 pancreatic cancer. The most common metastatic organ was the liver (n = 42, 79.25%). The survival rates after 1 and 3 years were 24 and 6%, respectively. The overall median time for survival was 5.1 months (range, 3 days to 62.4 months). According to the multivariate analysis, the staging at the time of diagnosis, serum albumin level, and tumor size were found to independently affect the survival rate. Twenty-two patients underwent endoscopic ultrasound-fine-needle aspiration with the sensitivity rate of 86.4% (19/22).

CONCLUSION

Because pancreatic cancer in Asians may be clinically similar to the disease in Caucasians, the goals of future research of the disease may also be similar in the two populations.

Sociodemographic trends in the incidence of pancreatic and biliary tract cancer in UK primary care

BACKGROUND

The UK incidence of pancreatic ductal adenocarcinoma (PDAC) is approximately 9/100,000 population compared with 1-2/100,000 for biliary tract cancer (BTC). This study explores the incidence of these cancers over time and the influence of socio-demographic and geographic factors in a UK primary care cohort.

METHODS

This study uses data from a large UK primary care database, The Health Improvement Network (THIN). All adult patients contributing data to THIN between January 2000 and December 2010 were included. Annual incidence rates were calculated, adjusted for age, gender, time period, deprivation score (Townsend quintile) and strategic health authority.

RESULTS

From 2000-2010, the annual incidence of PDAC increased by an average of 3% per year (95% CI 1.00-4.00%) and BTC by 4% (95% CI 2.00-6.00%). Incidence of both cancers increased steeply with age and was higher in men. BTC was associated with increasing deprivation (most deprived versus least deprived quintile (OR: 1.45 [95% CI: 1.17, 1.79.]).

CONCLUSIONS

The overall incidence of both cancers is low but increasing. Variations in incidence may reflect changes in coding practice or increased exposure to associated risk factors.

Pancreatic cancer mortality in Serbia from 1991-2010 - a joinpoint analysis

AIM

To analyze the trends of pancreatic cancer mortality in Serbia.

METHODS

The study covered the population of Serbia in the period 1991 to 2010. Mortality trends were assessed by the joinpoint regression analysis by age and sex.

RESULTS

Age-standardized mortality rates ranged from 5.93 to 8.57 per 100 000 in men and from 3.51 to 5.79 per 100 000 in women. Pancreatic cancer mortality in all age groups was higher among men than among women. It was continuously increasing since 1991 by 1.6% (95% confidence interval [CI] 1.1 to 2.0) yearly in men and by 2.2% (95% CI 1.7 to 2.7) yearly in women. Changes in mortality were not significant in younger age groups for both sexes. In older men (≥55 years), mortality was increasing, although in age groups 70-74 and 80-84 the increase was not significant. In 65-69 years old men, the increase in mortality was significant only in the period 2004 to 2010. In ≥50 years old women, mortality significantly increased from 1991 onward. In 75-79 years old women, a non-significant decrease in the period 1991 to 2000 was followed by a significant increase from 2000 to 2010.

CONCLUSION

Serbia is one of the countries with the highest pancreatic cancer mortality in the world, with increasing mortality trend in both sexes and in most age groups.

Nationwide improvement of only short-term survival after resection for pancreatic cancer in the Netherlands

OBJECTIVES

Evaluation of incidence, treatment, and survival trends after resection of pancreatic cancer at a national level.

METHODS

Using data on patient and tumor characteristics from the nationwide Netherlands Cancer Registry trends were analyzed for the period 1989-2008.

RESULTS

A total of 30,025 patients diagnosed with pancreatic cancer were included. The incidence remained stable over the 20-year study period at approximately 9 per 100,000 inhabitants. Resection rates increased from 8% in 1989 to 12% in 2008, adjuvant chemotherapy rates increased from 7% to 29%, and palliative chemotherapy rates increased from 5% to 19% (P < 0.0001 each). Relative survival proportions did not change over time; besides a minimal, nonsignificant increase at 3 months from 53% to 55%, these remained 34% at 6 months and 4.5% at 3 years. Among the patients undergoing tumor resection, relative survival increased from 82% to 93% at 3 months and from 51% to 63% at 1 year after diagnosis. However, no improvement was seen after 3 years (23%).

CONCLUSIONS

The increased short-term survival among patients who underwent resection probably reflects decreased postoperative mortality driven by ongoing centralization efforts. However, longer-term survival remained poor irrespective of the changes in management in the past decades.

Incidence and survival for hepatic, pancreatic and biliary cancers in England between 1998 and 2007

INTRODUCTION

Hepatic, pancreatic and biliary (HPB) cancers are a group of diverse malignancies managed ideally in specialist centres. This study describes recent patterns in the incidence and survival of HPB cancers in England over a ten year period (1998-2007).

METHODS

Data on 99,379 English patients (50,656 males; 48,723 females) diagnosed with HPB cancers between 1998 and 2007 were extracted from the National Cancer Data Repository. Data were divided into six site-specific cancer groups; pancreas, ampulla of Vater, biliary tract, primary liver, gallbladder and duodenum. Age-standardised incidence rates (per 100,000 European standard population, (ASR(E))) were calculated for each of the six groups by year of diagnosis and by socioeconomic deprivation. Survival was estimated using the Kaplan-Meier method.

RESULTS

The largest group was pancreatic cancers (63%), followed by primary liver (14%) and biliary cancers (13%). ASR(E) were highest for pancreatic and primary liver cancers whereas cancers of the gallbladder, duodenum and ampulla of Vater had a very low incidence. Over time the incidence of all six groups remained relatively stable, although primary liver cancer increased slightly in males. Incidence rates were higher in males than in females in all groups except gallbladder cancer, and all six groups had a higher incidence in the more deprived quintiles. Overall survival was poor in each of the HPB cancer groups.

CONCLUSIONS

HPB tumours are uncommon and are associated with poor long term survival reflecting the late stage at presentation. Incidence patterns suggest variable rates linked to socioeconomic deprivation and highlight a male predominance in all sites except the gallbladder. Identification of high risk populations should be emphasised in initiatives to raise awareness and facilitate earlier diagnosis.

Impact on mortality and cancer incidence rates of using random invitation from population registers for recruitment to trials

BACKGROUND

Participants in trials evaluating preventive interventions such as screening are on average healthier than the general population. To decrease this 'healthy volunteer effect' (HVE) women were randomly invited from population registers to participate in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and not allowed to self refer. This report assesses the extent of the HVE still prevalent in UKCTOCS and considers how certain shortfalls in mortality and incidence can be related to differences in socioeconomic status.

METHODS

Between 2001 and 2005, 202 638 postmenopausal women joined the trial out of 1 243 312 women randomly invited from local health authority registers. The cohort was flagged for deaths and cancer registrations and mean follow up at censoring was 5.55 years for mortality, and 2.58 years for cancer incidence. Overall and cause-specific Standardised Mortality Ratios (SMRs) and Standardised Incidence Ratios (SIRs) were calculated based on national mortality (2005) and cancer incidence (2006) statistics. The Index of Multiple Deprivation (IMD 2007) was used to assess the link between socioeconomic status and mortality/cancer incidence, and differences between the invited and recruited populations.

RESULTS

The SMR for all trial participants was 37%. By subgroup, the SMRs were higher for: younger age groups, extremes of BMI distribution and with each increasing year in trial. There was a clear trend between lower socioeconomic status and increased mortality but less pronounced with incidence. While the invited population had higher mean IMD scores (more deprived) than the national average, those who joined the trial were less deprived.

CONCLUSIONS

Recruitment to screening trials through invitation from population registers does not prevent a pronounced HVE on mortality. The impact on cancer incidence is much smaller. Similar shortfalls can be expected in other screening RCTs and it maybe prudent to use the various mortality and incidence rates presented as guides for calculating event rates and power in RCTs involving women.

Rising incidence of pancreatic cancer in France

OBJECTIVES

Time trends in the incidence of pancreatic cancer vary considerably between countries. The aim of this study was to provide time trends in incidence during a 25-year period in a well-defined French population.

METHODS

The cancer registry in Burgundy (France) was used to study time trends between 1981 and 2005 by sex, age, subsite, and histology. They were analyzed using an age-period cohort model.

RESULTS

Age-standardized incidence rates increased from 5.7 (1981-1985) to 7.9 per 100,000 (2001-2005) in men and from 2.6 to 4.6 in women. The mean percentage of variation by the 5-year period was +9.9% (P < 0.001, 95% confidence interval, 6.2%-13.6%) and +13.4% (P = 0.004, 95% confidence interval, 9.4%-17.5%), respectively. The increase in incidence was higher for cancers of the tail and corpus than for cancers of the head of pancreas and for malignant pancreatic endocrine tumors than for adenocarcinomas. The cumulative risk of developing a pancreatic cancer rose from 0.51% for men born in 1900 to 1.13% for those born in 1950. It was 0.34% and 0.55% for women, respectively.

CONCLUSIONS

The incidence of pancreatic cancer has increased sharply in France both by period and by birth cohort. Etiological studies are required to explain the increase in the incidence.

Epidemiology of pancreatic cancer in Norway: trends in incidence, basis of diagnosis and survival 1965-2007

OBJECTIVE

Pancreatic cancer is the second most frequent gastrointestinal cancer in the Western world. Few reports on concomitant trends in pancreatic cancer incidence, diagnosis, mortality and survival exist at the national level. This study provides a baseline overview of the temporal patterns in these four indicators over the past four decades in Norway.

MATERIAL AND METHODS

We analysed trends in incidence, basis of diagnosis, relative survival and mortality from the Cancer Registry of Norway for the period 1965-2007.

RESULTS

Included were 21,663 patients with pancreatic cancers. Incidence and mortality rates remained at around 6-8 per 100,000 over the study period. Diagnoses based on clinical examination alone dropped from 12.5% (in the 1950s) to <1% (in the 2000s), while use of imaging techniques, such as CT and MRI, increased from 3.6% to >30%. Previously high rates of autopsy-verified diagnosis and non-therapeutic surgery decreased accordingly. Consistently more primary tumours (from 12.9% to 19.4%) and metastases (from 12.5% to 22.4%) had histological examination, and use of endoscopy increased to approximately 10%. Relative survival after diagnosis of pancreatic cancer remains very low. However, in recent years, a modest improvement in short-term survival has been noted, with 1-year survival rates of 18% and 16% for males and females, respectively.

CONCLUSIONS

The incidence and mortality for pancreatic cancer remain largely unchanged, with few 5-year survivors. Improved short-term survival may reflect more aggressive use of surgery and chemotherapy. Further elucidation of risk factors in pancreatic cancer is needed to enable effective prevention, early detection and improved treatment strategies.

Distal pancreatectomy combined with celiac axis resection in treatment of carcinoma of the body/tail of the pancreas: a single-center experience

BACKGROUND

Few comparison studies have been carried out on patients with distal pancreatectomy (DP) combined with celiac axis (CA) resection. The aim of this study was to assess the safety and efficacy of this extended procedure in treatment of advanced carcinoma of the body/tail of the pancreas.

METHODS

This was a retrospective analysis of 206 patients with carcinoma of the body/tail of the pancreas from January 2003 through June 2008. Patients were divided into three groups based on the relationship of tumor and CA/common hepatic artery (CHA) as well as different treatment strategies. Data for operation time, blood loss, complications, and survival time were collected and statistically analyzed.

RESULTS

Sixty-five patients (31.6%) received radical distal pancreatectomy (DP), including 11 patients who underwent DP combined with celiac axis resection (group A) and 54 patients who received conventional DP (group B). Twenty patients did not undergo DP because of CA and/or CHA invasion only (group C). Group A had longer mean operative time than group B (323 versus 225 min, P = 0.000); there was no difference in mean estimated blood loss, percentage of pancreatic fistula or median survival time (14 versus 15 months, P = 0.197). However, group A had significantly prolonged median survival time compared with the 20 patients in group C (14 versus 5 months, P = 0.013), and quality of life was also dramatically improved.

CONCLUSIONS

DP combined with CA resection can be safely performed in certain patients with carcinoma of body/tail of the pancreas and significantly improves patient survival and quality of life.

Sixty-one years of pancreatic cancer in Denmark from 1943 to 2003: a nationwide study

OBJECTIVES

We report the incidence rates of pancreatic cancer in Denmark during 61 years of data registration, from 1943 to 2003.

METHODS

On the basis of reports in the nationwide, population-based Danish Cancer Registry, we calculated age-standardized, period-specific incidence rates of pancreatic cancer.

RESULTS

A total of 32,654 incident cases of pancreatic cancer were evaluated (male-female ratio, 1.4). The age-standardized incidence rate of pancreatic cancer increased steadily in the beginning of the study period from 3.75/100,000 person-years in 1943 to 1947 to the maximum of 9.96/100,000 person-years in 1968 to 1972 among men and from 2.95 in 1943 to 1947 to the maximum of 7.04 in 1978 to 1982 among women. The incidence rates declined between 1968 to 1972 and 1988 to 1992 for men and between 1978 to 1982 and 2003 for women. Most tumors were located in the exocrine pancreas, and most were adenocarcinomas. More than 40% were located in the head of the pancreas; 14% were localized, 21% were regionally spread, and 36% were metastatic at the time of diagnosis. During the period 1978 to 2003, the percentages of histologically or cytologically verified adenocarcinomas remained relatively steady, approximately 30%.

CONCLUSIONS

The incidence rate of pancreatic cancer increased at the beginning of the 61 years of registration and declined slightly thereafter.

Social inequality and incidence of and survival from cancers of the oesophagus, stomach and pancreas in a population-based study in Denmark, 1994-2003

We investigated the effect of socioeconomic, demographic and health-related indicators on the incidence of and survival from cancers of the oesophagus, stomach and pancreas diagnosed during 1994-2003 with follow-up through 2006 in Denmark using information from nationwide registers. The analyses were based on data on 2075 patients with cancer of the oesophagus, 2673 with stomach cancer and 3657 with pancreatic cancer in a cohort of 3.22 million persons born between 1925 and 1973 and aged >or=30 years. Overall, we found decreasing incidence rates of all three gastrointestinal cancers with increasing social advantage; this was most pronounced for oesophageal cancer and least for pancreatic cancer. The effect of socioeconomic position on survival after these cancers was less clear, perhaps due to the poor relative survival from these cancers and the fact that all three cancers are relatively rare in Denmark.

State-of-the-art magnetic resonance imaging of pancreatic cancer

Technical advances of magnetic resonance imaging (MRI), including ultrahigh-field magnetic resonance at 3.0 T, parallel imaging techniques, and multichannel receive coils of the abdomen, have promoted MRI of the pancreas. For adenocarcinoma, which is the most common malignant pancreatic tumor, helical CT has been most often used for detection and staging, but it has limitations in the detection of small cancers 2 cm in diameter or less (sensitivity, 63%). Moreover, it is not very accurate in determining nonresectability, because small liver metastases, peritoneal carcinomatosis, and subtle signs of vascular infiltration may be missed. At ultrahigh field at 3.0 T, gadolinium-enhanced MRI using volume-interpolated 3-dimensional gradient-recalled echo pulse sequences with near-isotropic voxels are very useful for detection of subtle abnormalities. Mangafodipir-enhanced MRI reveals a very high tumor-pancreas contrast, which helps to diagnose small cancers. Contrast-enhanced MRI is a problem-solving tool in case of equivocal CT: it helps to differentiate between cancer and focal pancreatitis. Neuroendocrine carcinoma may present with a spectrum of appearances at MRI, but the primary tumor and liver metastases are hypervascular in approximately 70%. In this article, pancreas imaging protocols for 1.5 and 3.0 T are explained. We present the imaging features of pancreatic cancer and the important questions in staging, which should be addressed by the radiologist.

Interpreting trends of pancreatic cancer incidence and mortality: a nation-wide study in Sweden (1960-2003)

OBJECTIVE

We investigated temporal trends of pancreatic cancer in Sweden measured with suboptimal sensitivity and specificity both by incidence and by mortality rates.

METHODS

46,257 incident cases of pancreatic cancer from the Swedish Cancer Register and 53,686 mortality cases from the Causes of Death Register during 1960-2003 were used to calculate age-standardized incidence or mortality rates. We further assessed the impact of changes in diagnostic practice on the observed trends, and investigated the effect of calendar period and birth cohort by age-period-cohort modeling.

RESULTS

Overall, the pattern of trends in age-adjusted rates of pancreatic cancer was similar irrespective of whether incidence or mortality was used. The age-adjusted rates of pancreatic cancer increased during the first decade and then peaked for both sexes (the male peak occurred in the early 1970s and the female peak in the 1980s) followed by a steady decline in both groups. An age-period model provided the best fit to the observed trends among patients diagnosed at ages 35-74 in both sexes.

CONCLUSION

The close agreement between the incidence and mortality and the gender disparity suggest a true decline in pancreatic cancer incidence in recent years in Sweden, and gender-specific trends in exposure to environmental risk factors.

Usefulness of technetium-99m hexamethylpropylene amine oxime-labeled leukocyte scintigraphy to detect pancreatic necrosis in patients with acute pancreatitis. Prospective comparison with Ranson, Glasgow and APACHE-II scores and serum C-reactive protein

BACKGROUND

In acute pancreatitis (AP), pancreatic necrosis (PN) is an important local complication that can be identified by means of contrast-enhanced computed tomography (CECT). Pancreatic leukocyte infiltration is a significant pathogenic event in the development of PN that can be detected by labeled leukocyte scintigraphy (LLS). The aim of this study was to evaluate the utility of LLS with technetium-99m hexamethylpropylene amine oxime ((99m)Tc-HMPAO) to detect the presence of PN in patients with AP.

METHODS

Prospective cohort study of 84 patients with AP. Patients underwent LLS and the activity of images was scored on a 0-3 scale. CETC was performed to assess PN. Ranson, Glasgow and APACHE-II scores were calculated. Serum C-reactive protein (CRP) was measured. Sensitivity (Sn), specificity (Sp), positive predictive values (PPV), negative predictive values (NPV), areas under receiver operating characteristic (ROC) curves, likelihood ratios, odds ratios, analysis of variances between groups and correlation coefficients between tests were calculated.

RESULTS

PN was present in 11 (13%) patients. Pancreatic labeled leukocyte uptake was present in 38 patients (45%). Sn, Sp, PPV and NPV of LLS grade 2-3 for PN diagnosis were the highest (91, 88, 53 and 98%, respectively) of all tests. Patients with LLS grade 2-3 were 71 times more likely to be at risk of PN compared to those with LLS grade 0-1. The area under ROC curve of the LLS was the largest. A significant correlation was obtained between LLS and CRP (p < 0.001).

CONCLUSION

In patients with AP, LLS with (99m)Tc-HMPAO detects PN with an acceptable level of confidence and therefore could be considered an alternative technique to CECT in detecting PN.

Tumor M2-pyruvate kinase as tumor marker in exocrine pancreatic cancer a meta-analysis

OBJECTIVES

Tumor M2-pyruvate kinase, a tumor-associated dimeric form of enzyme pyruvate kinase, is commonly elevated in pancreatic cancers. This meta-analysis aimed to evaluate its diagnostic utility in comparison to carbohydrate antigen 19-9 (CA19-9) in pancreatic cancer.

METHODS

A literature search was conducted for entries from 1951 to 2006 using PubMed, Embase, Central, and SCI Expanded databases using M2 pyruvate kinase AND pancreatic cancer/s OR tumor/s as keywords. A total of 258 references were retrieved. Of these, 118 duplicates were removed and 132 references were excluded. All studies comparing TuM2-PK with CA19-9 in pancreatic cancer were included. Full text was obtained for 8 references of 7 included studies. Diagnostic odds ratio (DOR) and 95% confidence interval (CI) was calculated from the available specificity and sensitivity for each study and were pooled to give overall DOR and 95% CI for TuM2-PK and CA19-9. Receiver operator characteristic curve was calculated to give overall specificity and sensitivity for TuM2-PK.

RESULTS

The diagnostic performance of TuM2-PK (DOR, 35; 95% CI, 19.7-62.3) was similar to those of CA19-9 (DOR, 44; 95% CI, 26.5-73.1). The overall specificity for TuM2-PK was 60% with corresponding sensitivity of 95%.

CONCLUSION

Efficacy of TuM2-PK as a tumor marker is similar to that of CA19-9. Further trials are needed to use it alone or in combination with CA19-9 in patients with suspected pancreatic cancer.

Trends in pancreatic cancer incidence in nine SEER Cancer Registries, 1973-2002

BACKGROUND

The evolution of pancreatic cancer incidence in the last three decades in the United States remains unclear. This study was conducted to investigate this problem, using data from the nine registries of the Surveillance, Epidemiology, and End Results (SEER) Program.

PATIENTS AND METHODS

The incidence data in 1973-2002 were age standardized to the 2000 USA standard population and analyzed by the joinpoint regression.

RESULTS

For the nine registries combined, pancreatic cancer incidence in men significantly decreased by 0.62% per year from 1973 to 2002. Incidence in women increased until 1984 and slowly declined thereafter. A rise in incidence, although not statistically significant, has been noted in young and middle-aged adults (<60 years) since 1994. Changes in incidence over time substantially differed among the nine SEER registries compared. Incidence decreased in most age-, sex-, and race-specific groups of the populations covered in the nine registries during the period examined. Conversely, a statistically significant increase in incidence was observed among women in Hawaii and Iowa and among old adults (> or =60 years) in Seattle and Utah.

CONCLUSIONS

Pancreatic cancer incidence significantly decreased from 1973 to 2002 in men and increased until 1984 and then declined slowly in women in the United States.