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Clinical profile of pancreatic adenocarcinoma
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Received: ,
Accepted: ,
How to cite this article: Reddy MBK, Shetty N, M PY, Shet D, Marakkada S. Clinical profile of pancreatic adenocarcinoma. South Asian J Cancer. 2026;15:88-92. doi: 10.25259/SAJC_23_2025
Abstract
Objectives:
Pancreatic adenocarcinoma (PAC) is an aggressive malignancy with poor survival, often diagnosed at advanced stages. This study evaluated the clinical features, tumour characteristics, and treatment patterns at a tertiary care hospital in South India.
Material and Methods:
A retrospective cross-sectional analysis was conducted on 205 PAC patients (2015–2022) at a tertiary care hospital in South India, Mangalore. Data on demographics, presentation, tumour characteristics, treatment modalities, and outcomes were collected from hospital records.
Results:
A total of 205 patients were included, with a median age of 60–70 years and a slight female predominance. The majority had periampullary tumours and advanced-stage disease at presentation. Kaplan–Meier analysis showed significantly better survival with adjuvant chemotherapy compared to palliative intent (p = 0.003), while upfront surgery showed a trend toward improved survival without statistical significance.
Conclusion:
PAC in this cohort presented late with poor survival. Periampullary predominance, prognostic value of CA 19-9, and limited neoadjuvant use were noted. Multimodal therapy improved outcomes, underscoring the need for early detection and optimised treatment strategies.
Keywords
Abdominal pain
CA 19-9
Jaundice
Pancreatic adenocarcinoma
Whipple’s procedure
INTRODUCTION
Pancreatic adenocarcinoma (PAC) is a highly aggressive and deadly cancer, with a 5-year survival rate under 5%. In 2020, pancreatic cancer (PC) was the 12th most common cancer worldwide and the ninth largest cause of cancer-related deaths worldwide.[1]
Pancreatic cancers have a high mortality rate due to early metastatic spread and resistance to radiation and chemotherapy, despite advancements in tumour biology over the past decade.[2]
The precise cause of pancreatic cancer remains unclear. However, smoking is a known environmental risk factor, increasing the risk by roughly three times. Furthermore, less than 5% of instances of pancreatic cancer are thought to be caused by hereditary or family factors.[3] Alcohol is also one of the known risk factors for several cancers; its association with pancreatic cancer appears weak or inconclusive.[4] Less than 5% of the population is linked to inherited or genetic factors.[5] The most predominant form of pancreatic cancer is extremely aggressive, with early metastasis, late detection, and poor survival.[6]
Pancreatic cancer is typically diagnosed in its advanced stages. Therefore, it has a dismal prognosis with a high mortality rate. In its early stages, pancreatic cancer frequently shows no symptoms; it usually becomes apparent when the tumour grows to distant organs or invades neighbouring tissues. The majority of people exhibit symptoms after the disease has progressed. Pancreatic cancer often presents with abdominal pain, obstructive jaundice, and weight loss due to anorexia, poor digestion due to pancreatic duct obstruction, or cancer-related cachexia.[7,8] Most pancreatic tumours occur in the head region and are detected earlier due to bile duct blockage, whereas tumours in the body and tail often remain asymptomatic until advanced stages.[9] High CA19-9 levels are associated with advanced-stage disease.[10]
Pancreatic adenocarcinoma diagnosis and treatment are challenging due to its advanced stage, aggressive nature, early spread, and absence of early symptoms. The lack of effective systemic therapies complicates management. As a result, only a small proportion of patients are eligible for surgical resection with curative intent at the time of diagnosis.[11] One-year survival rate in Pancreatic adenocarcinoma has marginally increased over the past 5 years, primarily due to advances in first-line chemotherapy regimens, whereas 5 year survival rate remained less than 5%.[12]
Only 20% of pancreatic cancer cases are detected early, with surgical resection being the preferred treatment. Recent randomised controlled trials show adjuvant therapy improves overall survival, and in some cases, neoadjuvant chemotherapy is recommended to improve surgical margins and increase the likelihood of operability.[13]
Despite multimodal treatment strategies aimed at improving survival and reducing toxicity, fewer than 5% of pancreatic adenocarcinoma patients survive five years, prompting ongoing efforts to enhance early diagnosis and systemic therapies.[14] Due to the complex and multifactorial nature of pancreatic carcinogenesis, interactions among various risk factors may occur.[15] Poor survival is linked to liver metastases and low nutritional markers, such as serum albumin level and total protein level.[16] A clearer understanding of survival variations may help reveal the causes of pancreatic cancer and improve survival across all histological types.[17] Survival outcomes in pancreatic cancer have progressed more slowly than those observed in most other cancers. [18]
The objective was to identify common presentations, management approaches, and survival trends to provide insights that may guide future strategies for early diagnosis and improved care.
MATERIAL AND METHODS
This is a cross-sectional, observational, and retrospective study conducted over a period of seven years, from 2015 to 2022, at a tertiary care hospital in Mangalore. The study included a sample size of 205 patients diagnosed with pancreatic adenocarcinoma. We obtained data from the Hospital Information System (HIS) and included patients who met the inclusion criteria: individuals aged 18 to 80 years, irrespective of gender, diagnosed with pancreatic adenocarcinoma, and those with co-morbid conditions. Patients below 18 years of age and those with an endocrine tumour of the pancreas were excluded from the study. The study focused on describing the clinical presentation, including symptomatology, tumour markers, tumour characteristics, and patterns of care in this patient population.
Statistics
The study used the Statistical Package for the Social Sciences (SPSS) for data analysis, presenting continuous variables as medians or means, and categorical variables as frequencies and percentages. p-values were two-tailed, with statistical significance defined as p <0.05. Overall survival was measured from diagnosis to death, with the Kaplan-Meier method used for survival estimates. Patients lost to follow-up were censored at the analysis time.
RESULTS
Patient characteristics
The study cohort comprised 205 patients. The largest proportion of patients belonged to the 60–70-year age group (27.8%), followed by the 50–60-year age group (26.8%). A slight predominance of females was observed, with females (52.2%) compared to males (47.8%) [Table 1].
| 1. | Age in years- median (range) | 60-70 yrs (27.8) |
| 2. | Sex -n (%) | |
| Male | 98 (47.8) | |
| Female | 107 (52.2) | |
| 3. | Jaundice presentation- n (%) | 97 (47.3) |
| 4. | Ca 19.9 Value- n (%) | |
| High | 121 (59.0) | |
| Normal | 40 (19.5) | |
| 5. | Presenting complaints - n (%) | |
| Pain abdomen | 103 (50.2) | |
| Jaundice | 73 (35.6) | |
| Vomiting | 15 (7.3) | |
| Others | 14 (6.8) | |
| 6. | Site of tumour -n (%) | |
| Periampullary | 125 (60.9) | |
| Body | 66 (32.1) | |
| Ampullary | 8 (3.9) | |
| Tail | 6 (2.9) | |
n represents the number of patients.
Abdominal pain was the most common presenting symptom (50.2%), followed by jaundice (35.6%), while vomiting (7.3%) and other nonspecific complaints (6.8%) were less frequently reported. At the time of initial evaluation, 47.3% of patients had clinically evident jaundice. Serum CA 19-9 was elevated in 59.0% of patients.
The majority of tumours originated from the periampullary region (60.9%), with the pancreatic body being the next most common site (32.1%). At presentation, the majority of patients had advanced cancer, with Stage III (32.7%) and Stage IV (28.8%) being the most common, while only 11.7% had early-stage disease (Stage 0-I) [Table 1].
Treatment
Surgery was performed in 60 patients (29.3%). Among these, the Whipple procedure was the most prevalent (71.6%), followed by triple bypass (15.7%) and, less commonly, distal pancreatectomy with splenectomy or laparotomy with tumour excision (7%). Stenting was done in 15.6% of patients before definitive therapy [Table 2].
| 1. | Surgery -n (%) | 60 (29.3) |
| 2. | Chemotherapy + Radiation therapy-n (%) | 14 (6.8) |
| 3. | Chemotherapy - n (%) | |
| Adjuvant | 25 (36.0) | |
| Palliative | 30 (13.3) | |
| 4. | Stenting -n (%) | 32 (15.6) |
n represents the number of patients.
Only 6.8% underwent concurrent chemoradiotherapy (CTRT). Overall, 60 patients received chemotherapy, with adjuvant in 50%, palliative in 47%, and neoadjuvant in 3%. The most commonly used regimen was Inj. Gemcitabine + Oxaliplatin was administered to 31 patients (40.8%). This was followed by Inj. Gemcitabine alone in 14 patients (18.4%) and Inj. Gemcitabine + Carboplatin in 10 patients (13.2%).
A total of 6 patients (7.9%) received other regimens, including Inj. Gemcitabine + Nanoxel. Less frequently used regimens included Inj. Gemcitabine + Abraxane, Inj. Gemcitabine + Cisplatin, Inj. Folfox and Inj. Gemcitabine + Capecitabine, each prescribed to 2–3 patients (2.6–2.9%).
The least frequently utilised regimens were Tab. Gemcitabine + Oxaliplatin, Inj. FOLFIRINOX, Inj. Capecitabine + Oxaliplatin, Inj. Gemcitabine + Capeguard, Inj. Paclitaxel + Oxaliplatin, Inj. Paclitaxel + Gemcitabine, and Inj. Carboplatin + Etoposide, each administered to a single patient (1.3–1.4%) [Table 2].
Outcome
Among patients with pancreatic adenocarcinoma, 23 (11.2%) were alive, 128 (62.4%) had died, and 54 (26.3%) were lost to follow-up. Kaplan–Meier analysis showed a median survival of 20 months (95% CI: 3.0–37.0) in the adjuvant group versus 5 months (95% CI: 3.0–7.0) in the palliative group. Similarly, the mean survival estimate was higher in the adjuvant group (24.3 months) compared to the palliative group (8.7 months). The log-rank test revealed a statistically significant difference between the two groups (χ2 = 8.850, df = 1, p = 0.003), indicating that patients receiving adjuvant chemotherapy had a significantly better survival outcome than those on palliative chemotherapy [Figure 1].
The surgery group demonstrated a median survival of 7 months (95% CI: 2.5–11.5), compared to 4 months (95% CI: 2.9–5.1) in the non-surgery group. The mean survival was also greater with surgery (18.3 months) than without surgery (13.7 months); however, this difference was not statistically significant [Figure 1].
DISCUSSION
In our study involving 205 patients, we observed that females were affected more frequently than males, with a ratio of 1:1.1, which contrasts with findings from other studies.[12] Additionally, the majority of patients (27.8%) belonged to the age group of 60–70 years, a trend consistent with the findings of Dayem Ullah et al. [1]
According to our study, more than half of the patients (50.2%) reported having abdominal pain, which was followed by jaundice (35.6%). Interestingly, these findings differ from the study conducted by Gupta et al., which reported jaundice as the most common presenting complaint in (65, 32.0%) of patients, followed by abdominal pain in (39, 19.2%).[19] Variations in study populations, diagnostic timeframes, or healthcare-seeking behaviour might be the cause of this divergence.
The chemotherapy treatment pattern observed in our study is consistent with current clinical practice guidelines. Adjuvant chemotherapy has been proven to improve survival outcomes in pancreatic cancer patients. However, the use of neoadjuvant chemotherapy in PAC is limited. The most often utilised chemotherapy regimen in this study was a combination of gemcitabine and oxaliplatin. These findings are consistent with a study conducted by Kosmidis et al., which found that gemcitabine or gemcitabine-based combination chemotherapy is commonly used and regarded as the best first-line treatment for advanced pancreatic cancer.[13]
In the current study, 43(71.6%) patients underwent Whipple’s procedure. The median survival for resected patients was 7 months (95% CI, 2.52-11.47). These findings are consistent with expected outcomes when appropriate case selection and statistical methods are applied. Since many patients were lost to follow-up, it's possible that the follow-up methods used in this investigation were unable to determine the mortality status of certain members of the study group. Patients who underwent surgery in this study and received adjuvant treatment had a decreased risk of early mortality with a median survival of 20 months. This result is consistent with the study conducted by Cress et al. [12]
TAKE HOME MESSAGE
Our findings highlight the limited uptake of upfront surgical interventions, reflecting the aggressive nature of pancreatic cancer and the high prevalence of advanced-stage disease at diagnosis. The preference for gemcitabine-based chemotherapy regimens aligns with their established efficacy and tolerability, while the low usage of neoadjuvant chemotherapy suggests its limited clinical adoption in this population. Patients undergoing surgical resection followed by adjuvant therapy demonstrated improved survival outcomes, underscoring the importance of multimodal treatment approaches. However, the challenges of early diagnosis, systemic treatment development, and effective follow-up remain critical areas for future research to enhance survival and quality of life for pancreatic cancer patients.
Ethical approval:
The study approved by the Institutional Ethics Committee at Father Muller Medical College, number FMIEC/CCM/724/2024, dated 11th September 2024.
Declaration of patient consent:
Patient's consent not required as patients identity is not disclosed or compromised.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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