Comparison of the risk factors and initial presenting symptoms to stage of disease in pancreatic ductal adenocarcinoma patients at Chris Hani Baragwanath Academic Hospital
Background: Pancreatic adenocarcinoma (PDAC) is the second leading cause of death in the US amongst both sexes and patients often present with advanced disease. Where many studies have described the risk factors, symptoms, biochemistry and staging of the disease, none have assessed the risk factor profile and presenting symptoms according to the stage of the cancer in a black South African population. Objectives: To assess the initial risk factor profile, presenting symptoms and biochemistry according to stage in Black South African patients with diagnosed PDAC at Chris Hani Baragwanath Academic Hospital. Methods: A retrospective study including 71 patients with diagnosed PDAC from the Hepatobiliary unit database at CHBAH. We determined the TNM staging of each tumor from patient CT scans and correlated it to the demographic, biochemistry, risk factor and symptom data recorded in the patients file. Results: The study population had a mean (±SD) age at presentation of 59.9 (±10.8) years with a male predominance of 56.3% males. The majority of patients had stage 2 disease (35.2%). BMI and current smoking status differed significantly across the stages. The most common symptoms were abdominal pain (67.7%), jaundice (65.6%) and weight loss (50.8%), none of which were associated with PDAC stage. Lower platelet count, high GGT and elevated CA19-9 levels were significantly associated with advanced PDAC. Platelet count showed statistical significant in each T, N and M stage, respectively. Univariate logistic regression demonstrated that platelet count, CRP and CA19-9 values are significantly associated with metastasis. In a multivariate logistic regression model lower platelet count and increased CA 19-9 are independent predictors of metastatic disease in PDAC patients with 97% specificity and 83% PPV. Conclusion: Our data demonstrates that most risk factors or presenting symptoms show no association with PDAC stage, although it does illustrate the risk factors and clinical presentation that are prevalent in our population. Moreover, platelet count and CA19-9 are independent predictors of metastases in PDAC.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine
Lahoud, Nicola Ann (2019) Comparison of the risk factors and initial presenting symptoms to stage of disease in pancreatic ductal adenocarcinoma patients at Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, <http://hdl.handle.net/10539/29846>