Demographic and Clinical Characteristics of Patients With Pancreatic Cancer, A Study in Kerman, Iran

Purpose Pancreatic cancer (PC) has the worst prognosis among cancers and is the only cancer whose annual incidence is higher than its prevalence. Considering that many PC cases are annually diagnosed in the world, and the fact that the disease has the worst prognosis among cancers, and the prevalence of its risk factors such as diabetes, high-fat diets, smoking, population aging, etc. has been on the rise, the incidence of PC is expected to increase in the future. So, our aim was to assess the demographic features of PC patients in an Iranian population.


Introduction
Nowadays, gastrointestinal tumors are among the most common human cancers, killing thousands of people worldwide (1,2). Nearly 200,000 new cases of pancreatic cancer (PC) are annually reported across the world. Most of these cancers (about 95%) originate from the excretory region of the pancreas (3).
Pancreatic cancer has the worst prognosis among all cancers and is the only cancer whose annual incidence is higher than its prevalence (3). It is estimated that this cancer is responsible for around 30,000 deaths in the United States every year (4). In Iran, according to the reports of the Ministry of Health in 2003, 500 deaths were recorded in the country due to pancreatic and bile duct cancers (5).
The mean survival rate of PC patients after diagnosis is less than 6 months with a considerably lower rate in the people aged over 80 years (6). Numerous studies have mentioned several risk factors for PC, including demographic risk factors such as and advanced age, male gender, race (higher mortality in blacks), genetic factors (e.g., family history, hereditary non-polyposis colorectal cancer), ataxiatelangiectasia, Potts-Jagger syndrome, gastrectomy, diabetes, chronic pancreatitis, as well as environmental risk factors including smoking, occupational threats, and the food cooking method (7).
Smoking and advanced age are the only risk factors that con rmed in studies. (8). It has been estimated that smoking is responsible for 25 to 29% of PC cases (9).
The most common type of PC is pancreatic adenocarcinoma, which accounts for 85% of the cases.
Because many PC cases are annually diagnosed across the world, and the fact that the disease has the worst prognosis among cancers, and the prevalence of its risk factors such as diabetes, high-fat diets, smoking, population aging, etc. has been on the rise, the incidence of PC is expected to increase in the future (10). Considering that there were no updated data about PC patients' demographic features in Kerman province (Iran), this study was conducted to divulge these features in this region of the country.

Methods
The present study was a descriptive cross-sectional research conducted in the teaching hospitals a liated with Kerman University of Medical Sciences (i.e., Afzalipour and Bahonar hospitals) in 2018.
The study's statistical population included all the PC patients referred to the mentioned hospitals. The pathological and clinical data of all the patients diagnosed with PC from the beginning of 2009 to the end of 2019 (either those who underwent surgical tumor resection or those who received other alternative therapies) were recorded. Furthermore, patients' information such as age, sex, place of residence, type and date of surgery, date of hospitalization, surgery report, duration of chemotherapy or radiotherapy, symptoms and associated comorbidities, and pathology report were gathered. This study was approved by the Ethics Committee of Kerman University of Medical Sciences. Patients' names and other information were kept con dential. Finally, the data was entered into SPSS 20 software and analyzed.

Results
The current study was conducted to investigate the demographic characteristics of patients with PC in Kerman province (Iran), diagnosed during 2009-2019. Sampling was conducted via the census method to enroll all the patients diagnosed with this cancer during the study period. Overall, 380 patients with PC were examined, of whom 230 (60.5%) were male, and 150 (39.5%) were female. According to Table 1, most of the patients had an age between 61 to 70 years (26.1%). Among the patients, 36 (9.3%) had a history of alcohol consumption, of whom 22 (9.6%) were male, and 14 (9.3%) were female. Also, 129 (33.7%) patients had been exposed to smoke, of whom 70 (30.4%) and 59 (39.3%) were men and women, respectively. Regarding clinical symptoms and associated comorbidities, the results showed that the most common symptoms in the patients were jaundice (65.3%), abdominal pain (54.7%), and anorexia (50.7%). The least frequent symptom was pruritus (35.2%). Also, 160 (41.8%) patients demonstrated different underlying diseases, and a history of gallstones was noted in 117 (30.5%) cases (Table 2). As shown in Fig. 1, the most common location of tumor was the pancreas head (62.4%), followed by total (21.7%), the body (10.2%), and tail (5%).
The most common tumor types included adenocarcinoma (270, 71%), metastatic cancer (102, 26.9%), and nally endocrine tumors (8, 2.1%). Regarding the stage of tumors at the time of diagnosis, most patients were at the stage IV (67.6%) ( Table 3).  Most patients were in the age group of 61-70 years while the lowest ratio was related to the age group of 11-20 years. In accordance with our study, in a report by Raju et al., the mean age of patients at diagnosis was 70.3 ± 12.5 years (11). Most of the patients studied here lived in Kerman, followed by Jiroft and Bam cities. The least proportions of the patients were from Shahr-e-Babak and Baft cities.
Among the patients studied, 9.3% consumed alcohol, of whom 9.6% were men, and 9.3% were women. Furthermore, 33.7% of the patients were exposed to cigarette smoke, of whom 30.4% were men, and 39.3% were women. In agreement with these observations of ours, Shakeri et al. in their study showed that opium usage and alcohol consumption were associated with an elevated risk of PC; nevertheless, they found no association between smoking and the risk of this cancer (12).
The results of this study showed that the most common symptoms in PC patients were jaundice (65.3%), abdominal pain (54.7%), and anorexia (50.7%), respectively. On the other hand, pruritus, with a prevalence of 35.2%, was the least prevalent symptom among our PC patients. Among the patients, 41.8% had a history of various underlying diseases, and 30.5% of them also revealed a history of gallstones.
Our results showed that the most common site of tumor involvement was the pancreatic head (62.4%), and the most common tumor type was adenocarcinoma which was observed in 71% of the patients.

Conclusion
The results of the present study showed that most of the patients diagnosed with PC were males, belonged to the age group of 61-70 years. The pancreas head was the most common site of tumor involvement in both genders. The most common type of tumor in both men and women was adenocarcinoma. Palliative surgery was the most used treatment among all patients. Factors such as female gender, a history of gallstones, receiving palliative surgery or chemotherapy, and a history of underlying diseases were associated with increased survival rates in the patients.

Declarations
Ethical approval: This study was approved by the Ethics Committee of Kerman University of Medical Sciences.
Con ict of Interest: None.
Funding: None Figure 1 Tumor locations in patients with pancreatic cancer