Abstract
BackgroundPancreatic cancer has the worst survival rate among all cancers. Almost 70% of patients in the UK were diagnosed at Stage IV.AimThis study aimed to investigate the symptoms associated with the diagnoses of pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine neoplasms (PNEN), and comparatively characterise the symptomatology between the two tumour types to inform earlier diagnosis.Design and settingA nested case-control study in primary care was conducted using data from the QResearch® database. Patients aged ≥25 years and diagnosed with PDAC or PNEN during 2000 to 2019 were included as cases. Up to 10 controls from the same general practice were matched with each case by age, sex, and calendar year using incidence density sampling.MethodConditional logistic regression was used to investigate the association between the 42 shortlisted symptoms and the diagnoses of PDAC and (or) PNEN in different timeframes relative to the index date, adjusting for patients’ sociodemographic characteristics, lifestyle, and relevant comorbidities.ResultsA total of 23 640 patients were identified as diagnosed with PDAC and 596 with PNEN. Of the symptoms identified, 23 were significantly associated with PDAC, and nine symptoms with PNEN. The two alarm symptoms for both tumours were jaundice and gastrointestinal bleeding. The two newly identified symptoms for PDAC were thirst and dark urine. The risk of unintentional weight loss may be longer than 2 years before the diagnosis of PNEN.ConclusionPDAC and PNEN have overlapping symptom profiles. The QCancer® (pancreas) risk prediction model could be updated by including the newly identified symptoms and comorbidities, which could help GPs identify high-risk patients for timely investigation in primary care.
Highlights
Pancreatic cancer is the 10th most common cancer in incidence but represents the fifth most common cause of death owing to cancer in the UK
The risk of unintentional weight loss may be longer than 2 years before the diagnosis of pancreatic neuroendocrine neoplasms (PNEN)
Tumours arising from the pancreas can be classified as exocrine or neuroendocrine (≤5%) neoplasms,[2] known as pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine neoplasms (PNEN),[3] respectively
Summary
Pancreatic cancer is the 10th most common cancer in incidence but represents the fifth most common cause of death owing to cancer in the UK. Pancreatic cancer is very aggressive and has the worst survival rate among all types of cancer.[1] Almost 70% of patients were diagnosed at Stage IV. Tumours arising from the pancreas can be classified as exocrine (approximately 95%) or neuroendocrine (≤5%) neoplasms,[2] known as pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine neoplasms (PNEN),[3] respectively. Though there are differences in tumour pathobiology and treatment strategies between PDAC and PNEN, the two tumour types share a proclivity to metastasise.[4,5,6] More favourable outcomes were observed in diagnosis at earlier stages.[7]. Pancreatic cancer has the worst survival rate among all cancers. Almost 70% of patients in the UK were diagnosed at Stage IV
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