Performance of Different Comorbidity Indices in Predicting Mortality in Danish Pancreatic Cancer Patients

BackgroundPancreatic cancer has the highest mortality rate of all major cancers. This study aims to provide an updated analysis of the incidence, mortality, and temporal trends of pancreatic cancer by...

Background: Physical activity has been associated with a lower risk of various types of cancer and reduced cancer-specific mortality. Less is known about its impact on pancreatic cancer. The aim of this systematic review and meta-analysis was to summarize evidence on the association between physical activity and pancreatic cancer risk and mortality. Methods: PubMed and Embase were searched until May 2024 for studies examining physical activity in relation to pancreatic cancer incidence and mortality. Summary risk estimates for highest vs. lowest physical activity levels were calculated using a random-effects model. The risk of publication bias was assessed with a funnel plot and Egger's regression test. Results: A total of seven case-control and eighteen prospective cohort studies were included that investigated the association between physical activity and pancreatic cancer incidence. Our meta-analysis showed a summary estimate of 0.75 (95% CI 0.64-0.88) for case-control studies (I2 = 23%, n = 7) and a summary estimate of 0.91 (95% CI 0.86-0.97) for prospective cohort studies (I2 = 5%, n = 18). Among the six prospective cohort studies that assessed pancreatic cancer mortality, the summary estimate was 1.03 (95% CI 0.83-1.27), I2 = 50%. Conclusions: Higher levels of physical activity were associated with reduced pancreatic cancer risk. Evidence from a limited number of studies suggests that pre-diagnosis physical activity does not affect pancreatic cancer mortality.

Pancreatic cancer (PC) is the third leading cause of all cancer-related fatalities and accounts for approximately 3% of cancer cases in the United States. PC survival rates are lower in Blacks compared to other races, and this has been attributed to socioeconomic and genetic factors. In this study, we evaluated sociodemographic and genetic characteristics associated with PC incidence and mortality among Blacks. Data from the SEER 22 registries (2000-2020) were used to calculate the incidence rates and relative survival. County mortality rates from 2017 to 2021 were analyzed. Incidence rate ratios based on gender, age, primary disease site, stage, level of education, and poverty were calculated. Survival analysis was conducted using the Kaplan-Meier method. Mutant gene expression was obtained from the MSK-CHORD tumor registry. Overall, 48,606 Black patients were diagnosed with malignant PC between 2000 and 2020: females (53.53%) and males (46.47%). Both males and females experienced a slight increase in Annual Percent Change (APC) of PC incidence (0.24, 95% CI, -0.02-0.53) and (0.22, 95% CI, -0.05-0.51), respectively, from 2000 to 2020. Males aged 55 to 75 years were most frequently affected. Overall incidence risk from 2000-2020 by age was higher in Black males IRR > 1 (1.18, 95% CI, 1.16-1.21). The most common primary PC site for Black males and females was the head of the pancreas, 49.06% and 49.88%, respectively. By staging, distant PC had the highest frequency in Blacks. Poverty level was associated with PC incidence among females and PC mortality among both males and females. Stage was associated with survival among males with localized and regional PC. The 5-year relative survival was less than 11% across combined PC stages for both sexes. Black males had a relatively lower 5-year survival than Black females in localized (31.7 vs. 37.2%) and distant PC (2.6% vs. 2.90%). Mutant KRAS expression was higher in Black males. PC incidence and mortality were significantly higher in Black males. Our analysis points to the importance of poverty alleviation programs that target females are likely to reduce PC incidence. Furthermore, receiving recommended screening for PC and early-stage diagnostics is important to lower PC mortality.

Total antioxidant capacity (TAC) reflects an individual's overall antioxidant intake. We sought to clarify whether higher TAC is associated with lower risks of pancreatic cancer incidence and mortality in the U.S. general population. A total of 96,018 American adults were identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. A ferric-reducing ability of plasma score was used to reflect an individual's TAC intake from diet and/or supplements. Cox regression was used to calculate hazard ratios (HR) for pancreatic cancer incidence, and competing risk regression was used to calculate subdistribution HRs for pancreatic cancer mortality. Restricted cubic spline regression was used to test nonlinearity. A total of 393 pancreatic cancer cases and 353 pancreatic cancer-related deaths were documented. Total (diet + supplements) TAC was found to be inversely associated with pancreatic cancer incidence (HR quartile 4 vs. quartile 1 = 0.53; 95% confidence interval, 0.39-0.72; P trend = 0.0002) and mortality (subdistribution HR quartile 4 vs. quartile 1 = 0.52; 95% confidence interval 0.38-0.72; P trend = 0.0003) in a nonlinear dose-response manner (all P nonlinearity < 0.01). Similar results were observed for dietary TAC. No association of supplemental TAC with pancreatic cancer incidence and mortality was found. In the U.S. general population, dietary but not supplemental TAC level is inversely associated with risks of pancreatic cancer incidence and mortality in a nonlinear dose-response pattern. This is the first prospective study indicating that a diet rich in antioxidants may be beneficial in decreasing pancreatic cancer incidence and mortality.

ObjectiveThis study aimed to analyze the trends and epidemiological characteristics of pancreatic cancer (PC) mortality in China from 2004 to 2021, focusing on gender, age, and regional disparities. The goal was to provide a comprehensive understanding of PC mortality and identify key risk factors to support future prevention and control strategies.MethodsUsing data from the national Disease Surveillance Point (DSP) system, which covers a large and representative sample of the Chinese population, the study examined pancreatic cancer mortality trends across different age groups, sexes, and regions. Statistical analyses, including the independent-sample t-test and age-period-cohort (APC) model, were employed to assess mortality differences and annual percentage changes from 2004 to 2021.ResultsThe study recorded a significant increase in pancreatic cancer mortality, particularly among males and older adults. Mortality was consistently higher in urban areas, but the growth rate in rural areas surpassed that of urban areas. Regional disparities were also observed, with the eastern region showing the highest mortality rates but slower increases compared to the central and western regions. Key risk factors, including aging, diabetes, smoking, and chronic pancreatitis, were identified, with gender-specific differences linked to lifestyle factors such as smoking and alcohol consumption.ConclusionPancreatic cancer mortality in China has shown significant increases over the past 18 years, especially among males, older adults, and rural populations. The findings highlight the urgent need for targeted public health interventions to address gender- and age-specific risks, as well as healthcare access inequalities in less developed regions. Future research should focus on gathering more granular, individual-level data to better understand the complex interplay of risk factors and inform more effective prevention and treatment strategies.

To the Editors: Sinner et al. ([1][1]) report a lack of association between obesity and pancreatic cancer in a cohort study of elderly women with 209 cases of pancreatic cancer. These results are valuable given the prospective nature of the study. However, we disagree with the authors' conclusion

Objective: To analyze the trend of morbidity and mortality of pancreatic cancer in China from 2005 to 2015 and estimate the related age, period and cohort effect, respectively. Methods: Joinpoint regression analysis was used to analyze the trend of morbidity rate and mortality rate of pancreatic cancer during 2005-2015 and calculate the annual percentage change and average annual percentage change based on the data in the annual report of China Cancer Registry. Population aged 20-84 years was fitted by the Age-Period-Cohort model to estimate the effect parameters of age, period and cohort. Results: The trend variations of the crude morbidity rate and crude mortality rate of pancreatic cancer were consistent. The morbidity rate of pancreatic cancer firstly increased before 2008 and then decreased. The morbidity rate and mortality rate of pancreatic cancer were higher in men than women, and higher in urban areas than in rural areas. From 2005 to 2015, the overall age-standardized morbidity rate of pancreatic cancer increased by 2.78% annually and the overall age standardized mortality rate of pancreatic cancer increased by 2.24% annually. The age standardized morbidity of pancreatic cancer in rural men changed more rapidly, with an average annual increase of 3.74%, and the age standardized mortality rate of pancreatic cancer in urban men changed more rapidly, with an average annual increase of 3.57%. The age effect on the morbidity and mortality of pancreatic cancer increased with age, and the effect was most obvious in age group 70-80 years, the period effect increased over time and the cohort effect decreased with year, but rebound or fluctuation was observed after 1976. Conclusions: The morbidity rate and mortality rate of pancreatic cancer in China increased slightly in past decades. Strategies on effective prevention and control of pancreatic cancer should be developed in the future.

Simple SummaryPrior research has reported an association between 1,3-dichloropropene exposure and pancreatic cancer but was limited by data from a single state in the United States. The current study utilized an ecologic study design to examine the association between 1,3-dichloropropene and pancreatic cancer mortality rates using national-level United states data. Data on 1,3-dichloropropene use was collected from the U.S. Geologic Survey’s National Water-Quality Assessment Project, and pancreatic cancer mortality data was derived from compressed mortality files provided by the Centers for Disease Control and Prevention. Overall, no significant association was observed between 1,3-dichloropropene use and pancreatic cancer mortality rate; however, a significantly increased mortality rate was observed for the highest two quartiles of 1,3-dichloropropene use in states that reported use to the National Water-Quality Assessment Project for at least 20 years.Background: 1,3-Dichloropropene (1,3-D) is a soil fumigant that is used to protect fruit, vegetable, field, tree, and vine crops from nematode infestation and soil borne diseases. It is a commonly use pesticide, is applied by either direct injection into the soil or drip irrigation and is highlight volatile. Though currently classified as “Suggestive Evidence of Carcinogenic Potential”, the literature in animal-based studies has inconsistent results and there is limited research among a human population with one study only among the California population. The purpose of the current analysis is to conduct a state-level analysis of the association between 1,3-D and pancreatic cancer mortality. Methods: Data for this ecological study were derived from death certificate data (for pancreatic mortality) from 1999 to 2020 and United States Geologic Survey National Water-Quality Assessment project for years 1992–2016 (1,3-D use). A negative binomial regression adjusted for selected lifestyle risk factors of pancreatic cancer (i.e., obesity, alcohol use, and smoking prevalence) estimated rate ratios (RRs) and associated 95% confidence intervals (CIs)for the association between 1,3-D quartiles and pancreatic cancer mortality rate. Models lagged in five-year increments to account for the induction period of pancreatic cancer. Results: Overall, there was no association between 1,3-D quartile and pancreatic cancer mortality rate; however, limiting the analyses to states reporting 1,3-D use for at least 20 years, the highest quartile of 1,3-D use was associated with an 11% increase in the pancreatic cancer mortality rate in the five-year lagged model (RR 1.11, 95% CI 1.06–1.16). This association was consistent across the other lag periods. Conclusions: Accounting for lifestyle factors associated with pancreatic cancer risk, there is a significantly increase rate of pancreatic cancer mortality among states that have the highest quartile of 1,3-D use and have been using 1,3-D for a long-term period.

BACKGROUNDPancreatic cancer, as the one of most fatal malignancies, remains a critical issue in the global burden of disease.AIMTo estimate trends in pancreatic cancer incidence and mortality worldwide in the last three decades.METHODSA descriptive epidemiological study was done. Pancreatic cancer incidence and mortality data were obtained from the database of the World Health Organization. Analysis of pancreatic cancer incidence and mortality during 2020 was performed. The age-standardized rates (ASRs, expressed per 100000) were presented. To estimate trends of incidence and mortality of pancreatic cancer, joinpoint regression analysis was used: the average annual percent change (AAPC) with the corresponding 95% confidence interval (95%CI) was calculated. Additionally, analysis was performed by sex and age. In this paper, the trend analysis included only countries with high and medium data quality.RESULTSA total of 495773 (262865 male and 232908 female) new cases and 466003 (246840 male and 219163 female) deaths from pancreatic cancer were reported worldwide in 2020. In both sexes, most of the new cases (191348; 38.6% of the total) and deaths (182074; 39.1% of the total) occurred in the Western Pacific Region. In both sexes, the highest ASRs were found in the European Region, while the lowest rates were reported in the South-East Asia Region. The general pattern of rising pancreatic cancer incidence and mortality was seen across countries worldwide in observed period. Out of all countries with an increase in pancreatic cancer incidence, females in France and India showed the most marked rise in incidence rates (AAPC = +3.9% and AAPC = +3.7%, respectively). Decreasing incidence trends for pancreatic cancer were observed in some countries, but without significance. Out of all countries with an increase in pancreatic cancer mortality rates, Turkmenistan showed the most marked rise both in males (AAPC = +10.0%, 95%CI: 7.4–12.5) and females (AAPC = +6.4%, 95%CI: 3.5–9.5). The mortality trends of pancreatic cancer were decreasing in both sexes only in Canada and Mexico.CONCLUSIONFurther research is needed to explain the cause of large international differences in incidence and mortality trends of pancreatic cancer in last three decades.

The aim of the study was to evaluate the link between diabetes and pancreatic cancer (PC) mortality and the joint effect of smoking and insulin use on PC mortality. A total of 39,988 men and 46,909 women with type 2 diabetes, aged ≥25 years and recruited in 1995-1998, were followed to 2006 for PC mortality. Age-sex-specific mortality rate ratios for diabetic patients versus the general population were calculated. Cox regression was used to evaluate hazard ratios for PC mortality for covariates including age, sex, diabetes duration, body mass index, smoking, insulin use, and area of residence. The interaction and joint effect of smoking and insulin use were also evaluated. A total of 89 men and 63 women died of PC. The mortality rate ratios (95 % CI) showed a significantly higher risk in diabetic patients with a magnitude most remarkable at the youngest age: 1.51 (1.15, 1.98), 2.02 (1.35, 3.03), and 8.36 (5.39, 12.98) for ≥65, 55-64, and 25-54 years old, respectively, for men; and 1.16 (0.84, 1.59), 2.12 (1.39, 3.23) and 3.33 (1.14, 9.68), respectively, for women. In multivariable Cox regression analysis, only age was significantly predictive for PC mortality. Although smoking and insulin use might be associated with a 50 % higher risk when analyzed as individual risk factors, they did not reach statistical significance. The interaction term of smoking and insulin use was also not statistically significant in additional modeling. However, smoking and insulin use jointly increased the risk with an adjusted hazard ratio (95 % CI) of 3.04 (1.37, 6.73) when compared to patients who did not smoke and did not use insulin. Diabetic patients have a significantly higher risk of PC mortality. In patients with type 2 diabetes, smoking and insulin use may jointly increase the risk by threefold.

Background: Pancreatic cancer (PC) is as the twelfth most frequent cancer and the seventh most important cause of mortality by reason of cancer in the world. Being informed about the incidence and mortality of this cancer and the potential role of development is useful in health policy. The aim of this research is investigating disparities in the incidence and mortality of PC in the world countries in the year 2012.&#x0D; Methods: This study was an ecologic study in the World for assessing the correlation between Human Development Index (HDI) and its details (Gross national income (GNI) per capita, average years of schooling and life expectancy at birth) with age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of PC.&#x0D; Results: In total, 337872 new cases of PC occurred in 2012 around the world , that 178116 and 159711 cases take happen in men and women respectively, also at the same year 330391 deaths of PC occurred ,that 173,827 and 156564 cases were in men and women. In assessment the relationship between HDI and ASIR and ASMR of PC there is significant positive correlation equal to 0.767 (p &lt;0.001) between HDI and ASIR of PC, and a significant positive correlation equal to 0.776 (p &lt;0.001) between HDI and ASMR of PC.&#x0D; Conclusion: The incidence and mortality of PC has a significant positive correlation with the Human Development Index.&#x0D;

Pancreatic cancer burden across Southeast Asia from 1990 to 2021: An analysis of incidence and mortality based on the global burden of disease study 2021.

Introduction: Pancreatic cancer is a highly mortal disease that used to be rare but its incidence rate has increased in the last few decades. Despite declining overall cancer incidence and mortality rates in developed countries, pancreatic cancer tends to increase in both incidence and mortality. Previous studies showed a male predominance in pancreatic cancer in patients older than 35. However, considering the sudden rise in incidence in young females, a new survey is crucial to address the current pattern of pancreatic cancer distribution between males and females. Hormonal factors may play a role in the pathogenesis of pancreatic cancer. Objectives: This study aimed to evaluate the role of gender differences in mortality and incidence of pancreatic cancer in an ecological study based on data extracted from the GLOBOCAN project in 2020. Patients and Methods: An ecological study was carried out to assess gender disparity in pancreatic cancer incidence and mortality rates. The data used in the study were obtained from the Global Cancer (GLOBOCAN) project of the World Health Organization (WHO) in 2020 (https://gco.iarc.fr/). Results: The pancreatic cancer mortality rate worldwide (2020) was estimated at 466,003 cases, encompassing 246,840 cases (52.96%) among males and 219,163 cases (47.04%) among females. The study found that although there were differences in the mean pancreatic cancer incidence and mortality rates between males and females when measured by indicators such as number, ASR, and crude rate, these differences were not statistically significant. Conclusion: In conclusion, the pancreatic cancer incidence and mortality rate is increasing worldwide. In spite of the fact that men die from pancreatic cancer at a higher rate than women, there is no statistically significant difference between the two. Registration: The study protocol was registered on the Research Registry website with the unique identification number (UIN) researchregistry9598.

Pancreatic cancer is an important cause of cancer mortality in developed countries. This article examines time trends for pancreatic cancer mortality rates in 38 countries on five continents between 1955 and 1998. We used the World Health Organization database on Age-Standardized World Population pancreatic cancer mortality rates by gender and fitted these data with linear regression models. This allowed us to (1) investigate the statistical significance of temporal trends; and (2) consider differences in trends among countries; and (3) predict future pancreatic cancer mortality rates. Over 44 years, pancreatic cancer mortality rates increased for females worldwide. Pancreatic cancer mortality rates for men increased in Southern Europe. In contrast, pancreatic cancer mortality rates for men in North America and Oceania increased until about 1975 and then decreased or remained stable. Our predictive models suggest that by 2005 the relative burden of pancreatic cancer mortality will have shifted away from Northern Europe and North America toward Southern Europe and Asia. Future research on pancreatic cancer should concentrate separately on the assessment of risk attributable to exposure to environmental factors, lifestyle factors, genetic determinates of pancreatic cancer, and the interactive influences of these factors on pancreatic cancer.

Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium