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Can Symptom Clusters Predict Stage, Resectability, and Survival in Pancreatic Cancer?
Mehmet Salim Demir1, Gözde Ağdaş1
1Department of Medical Oncology, Van Training and Research Hospital, Van, Turkey.
Background:
Pancreatic cancer is most often diagnosed at an advanced stage because it develops silently, and its early symptoms are vague and nonspecific. Grouping patients by their primary symptom clusters could provide valuable prognostic insights, enabling more accurate predictions of the stage at diagnosis, the likelihood of surgical resection, and expected survival.
Methods:
Single-center retrospective cohort study of 164 adults with histologically confirmed pancreatic adenocarcinoma. Patients were grouped by primary symptom cluster: obstructive (jaundice/dark urine/pruritus/steatorrhea), systemic (anorexia, fatigue, weight loss, or dyspnea/neurologic), pain-predominant (abdominal/back/epigastric pain or acute pancreatitis), or control (asymptomatic/incidental).
Results:
The study included 164 patients with a median age of 69 years (range 57-81); 56.7% were male. At diagnosis, the overall stage distribution was as follows: stage I, 11%; stage II, 15.9%; stage III, 24.4%; and stage IV, 48.8%. Patients in the obstructive, systemic, and pain-predominant groups were more likely to present with advanced disease than those in the control group (p<0.05). Among the symptomatic groups, the systemic cluster had a higher proportion of advanced-stage cases compared with both the obstructive and pain-predominant groups (p<0.05). In contrast, no difference was found between the obstructive and pain-predominant groups (p>0.05). In Cox proportional hazards analysis, symptom cluster category, stage at diagnosis, surgical resection status, treatment rate, treatment type, and localization were identified as independent predictors of overall survival (p<0.05). Median survival was longest in the control group (37.6 months), followed by the obstructive (16.0 months), pain-predominant (11.8 months), and systemic (7.8 months) groups, with all between-group comparisons reaching significance (p<0.05).
Conclusion:
Presenting symptom clusters are strongly associated with disease stage, surgical resectability, and survival outcomes in pancreatic cancer. Early recognition of high-risk symptom profiles may improve surgical opportunities and outcomes.
