View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by SZTE Publicatio Repozitórium - SZTE - Repository of Publications original paper Available from: http://www.jgld.ro/wp/archive/y2016/n2/a15 DOI: http://dx.doi.org/10.15403/jgld.2014.1121.252.pcr Pancreatic Cancer: Multicenter Prospective Data Collection and Analysis by the Hungarian Pancreatic Study Group Gábor Lakatos1, Anita Balázs2, Balázs Kui2, Szilárd Gódi3, Ákos Szücs4, Andrea Szentesi2, Zsolt Szentkereszty5, Richárd Szmola6, Dezső Kelemen7, Róbert Papp7, Áron Vincze3, József Czimmer3, Gabriella Pár3, Judit Bajor3, Imre Szabó3, Ferenc Izbéki8, Adrienn Halász8, László Leindler9, Gyula Farkas Jr.9, Tamás Takács2, László Czakó2, Zoltán Szepes2, Péter Hegyi2,10, 11*, Zsuzsanna Kahán12,* 1) Dept. Oncology, St. Istvan Abstract and St. Laszlo Hospital and Out- Patient Department, Budapest; Background & Aims: Pancreatic cancer is a devastating disease with poor prognosis. There is very limited 2) 1st Dept. Medicine, University information available regarding the epidemiology and treatment strategies of pancreatic cancer in Central of Szeged; 3) 1st Dept. Medicine, Europe. The purpose of the study was to prospectively collect and analyze data of pancreatic cancer in the University of Pécs; 4) 1st Dept. Hungarian population. Surgery, Semmelweis University, Methods: The Hungarian Pancreatic Study Group (HPSG) organized prospective, uniform data collection. Budapest; 5) Institute of Surgery, Altogether 354 patients were enrolled from 14 Hungarian centers. Clinical Center, University of Results: Chronic pancreatitis was present in 3.7% of the cases, while 33.7% of the patients had diabetes. Debrecen; 6) Dept. Interventional Family history for pancreatic cancer was positive in 4.8%. The most frequent presenting symptoms included Gastroenterology, National pain (63.8%), weight loss (63%) and jaundice (52.5%). The reported frequency of smoking and alcohol Institute of Oncology, Budapest; consumption was lower than expected (28.5% and 27.4%, respectively). The majority of patients (75.6%) were 7) Dept. Surgery, University diagnosed with advanced disease. Most patients (83.6%) had a primary tumor located in the pancreatic head. of Pécs; 8) 1st Dept. Medicine, The histological diagnosis was ductal adenocarcinoma in 90.7% of the cases, while neuroendocrine tumor Szent György University was present in 5.3%. Biliary stent implantation was performed in 166 patients, 59.2% of them received metal Teaching Hospital of County stents. Primary tumor resection was performed in 60 (16.9%) patients. Enteral or biliary bypass was done Fejér, Székesfehérvár; 9) Dept. in 35 and 49 patients, respectively. In a multivariate Cox-regression model, smoking status and presence of Surgery, University of Szeged; gemcitabine-based chemotherapy were identified as independent predictors for overall survival. 10) Hungarian Academy of Conclusion: We report the first data from a large cohort of Hungarian pancreatic cancer patients. We identified Sciences, University of Szeged, smoking status and chemotherapy as independent predictors in this cohort. Momentum Gastroenterology Multidisciplinary Research Group; Key words: pancreatic cancer – Hungarian cohort – acute pancreatitis – chronic pancreatitis – diabetes mellitus. 11) Institute for Translational Medicine & 1st Department of Abbreviations: EBM: evidence-based medicine; EPI: exocrine pancreatic insufficiency; FNAB: fine needle Medicine, University of Pécs; 12) aspiration biopsy; HPSG: Hungarian Pancreatic Study Group; MDCT: multi-detector computed tomography; Dept. Oncotherapy, University of OS: overall survival; PC: pancreatic cancer; RPP: Registry for Pancreatic Patients Szeged, Hungary Address for correspondence: Prof. Dr. Peter Hegyi Introduction the seventh, and the mortality rate is the fifth among all cancers University of Pécs; Centre for [2]. In Hungary both the incidence and mortality are one of Translational Medicine; Pancreatic cancer (PC) is the highest in Europe. There were 2,373 newly diagnosed PC Pécs, Hungary one of the most aggressive types patients in Hungary in 2010, and 1,837 died due to the disease [email protected] of human malignancies and a [3]. major health problem. Pancreatic The number of patients with PC is increasing globally. It Received: 11.12.2015 cancer is a relatively rare type is estimated that in 2012 there were 103,773 newly diagnosed Accepted: 26.02.12016 of tumor, but due to its high cases and 104,463 fatal outcomes in Europe [4]. There are mortality rate it is one of the most no screening tests for early detection of PC. By the time of *the last two authors equally frequent causes of cancer death diagnosis, less than 15% of patients can be offered a potential contributed to this work in the world.[1] In developed curative treatment, and up to 30% of the patients die within countries the incidence of PC is 12 months [5]. J Gastrointestin Liver Dis, June 2016 Vol. 25 No 2: 219-225 220 Lakatos et al Data suggest that the onco-epidemiological situation the number of patients enrolled by each center are summarized related to pancreatic cancer in Central European countries in Table I. is even worse compared to that in the Western world [6]. An Demographic data, data of possible risk factors, symptoms, epidemiologic analysis from 51 countries across the world has diagnosis, staging, therapy and survival were assessed. Data shown the highest mortality rates in Central Europe with trends collection was performed using a web-based electronic data towards increasing mortality in Romania, along with Albania, collection method as part of the Registry for Pancreatic Patients Spain and Croatia [7]. An epidemiologic study conducted in (RPP). Serbia between 1991 and 2010 demonstrated high mortality Demographic data included age and gender of patients. rates with increasing mortality trend in both genders and in Information about alcohol consumption and smoking most age groups [8]. (frequency and total amount of daily consumption), body mass There is only limited information available on the index (BMI), history of acute and chronic pancreatitis, diabetes management of PC from Central Europe including Hungary. mellitus and familial PC has been collected as possible risk In order to improve outcome of PC, it is essential to determine factors. Frequency of symptoms and clinical signs, such as fever, which factors contribute to the unfavorable trends seen in less pain, diarrhea, jaundice and weight loss were also evaluated. developed countries. The main purpose of our study was to Cancer related data included the date of diagnosis, extension collect information regarding the diagnosis, management and of the disease, location of the primary tumor, histological type, outcome of pancreatic cancer in Hungary. Here we present the method used to obtain histological diagnosis and the level the first large prospectively collected and analyzed data of of CA 19-9 at the time of diagnosis. Diagnosis and staging pancreatic cancer in the Hungarian population. of pancreatic cancer was based on imaging tests including multi-detector computed tomography (MDCT), magnetic Patients AND Methods resonance imaging (MRI), endoscopic retrograde cholangio- pancreatography (ERCP) and endoscopic ultrasonography The Hungarian Pancreatic Study Group (HPSG) was (EUS). Primary resectable tumor, locally advanced and established in 2011 in order to improve the care of patients metastatic disease were distinguished. Histological diagnosis suffering from pancreatic diseases. To achieve our aims we was performed using brush cytology during ERCP, fine needle (i) developed an electronic data registry for patients (www. aspiration biopsy (FNAB) or surgical biopsy/resection. pancreas.hu), (ii) published the currently available evidence- The database included information on endoscopic, surgical, based medicine (EBM) guidelines [9-13], (iii) established oncological and supportive therapy performed. The proportion specific study sessions including the pancreatic cancer one, of plastic or metal stents used for biliary drainage was (iv) and organized multicenter clinical trials [14-17]. determined. Information on the frequency of duodenal stent For this study the HPSG collected data from patients implantation was also recorded. Data on surgical resection diagnosed with PC between September 2012 and March (including margin status; R0, R1, R2) has been collected for 2014 using uniform questionnaire and clinical data sheets. patients with a resectable primary tumor. Palliative biliary Patients were enrolled from 14 Hungarian centers including and enteral bypass were recorded as well. If a patient received endoscopy units, gastroenterological, oncological and surgical oncological treatment (radiation therapy or chemotherapy) departments. The characteristics of the single departments and for PC, the type and intent (neo-adjuvant, adjuvant, palliative) of therapy and the name of the chemotherapeutic agent used Table I. Characteristics of the participating centers Name of institution Type of institution Department profile Number of patients enrolled (n) Borsod-Abaúj-Zemplén County General Hospital, Miskolc General Hospital Gastroenterology 2 Bács-Kiskun County Municipality Hospital, Kecskemét General Hospital Gastroenterology 2 Pándy Kálmán Békés County Hospital, Gyula General Hospital Gastroenterology 11 Department of Interventional Gastroenterology, National National Institution Endoscopy Unit 27 Institute of Oncology, Budapest Institute of Surgery,