Clinicopathological characteristics of pancreatic cancer and their association with mortality rate within a year of diagnosis at uganda cancer institute: a five-year retrospective cross-sectional study.

Abstract

Introduction: Pancreatic cancer is increasingly prevalent in low- and middle-income countries with a poor prognosis. However, its clinico pathological characteristics and outcomes are not well documented in Uganda. Objective: To describe the clinicopathological characteristics of pancreatic cancer and their association with one-year mortality at Uganda Cancer Institute. Methods: A five-year retrospective chart review (July 2018-june 2023) was conducted at UCI, analysing medical records of patients with histologically confirmed and/or radiologically highly suggestive of pancreatic cancer. Data on Socio-demographics, clinical characteristics, histopathological features, radiological features, and one-year mortality were collected using a pre-tested pre-coded tool. Outcomes about whether alive or dead were verified via medical records and telephone follow-ups. Statistical analysis was performed using STATA 16.0 with logistic regression to assess associations between clinicopathological characteristics and one-year mortality (odds ratios-OR and 95%confidence intervals). A p-value <0.05 was considered statistically significant. Results: Of 138 patients (46.4% male and 53.6% female, mean age 54.2 years), epigastric pain was the most common symptom (84.9%) with a median symptom duration of 3.5 months. Tumours were predominantly located in the pancreatic head (68%), followed by the body (21.5%), tail (6.2%), and mixed locations at 4.6%. Adenocarcinoma was the most common histological type (93.8%), followed by intraductal papillary mucinous neoplasm (2.3%), pancreatic neuroendocrine neoplasm (0.8%), acinar cell carcinoma (1.6%), and solid pseudopapillary neoplasm 1.6%. Most tumours were moderately differentiated tumours (58.5%), 31.7% poorly differentiated tumours, and 9.8% well differentiated tumours. The one-year mortality rate was 69.5% with 60%of deaths occurring within 3 months of diagnosis. Weight loss (p value 0.025), low albumin levels (p value 0.023), and elevated levels of CA 19-9(p value 0.029) were significantly associated with mortality. Conclusion: Pancreatic cancer in Uganda primarily affects middle-aged individuals with a slight female predominance and is associated with a high one-year mortality rate (69.5%), driven by late presentation (stage III and IV). Weight loss, low albumin, and elevated CA 19-9 are significant predictors of mortality.