Background: Pancreatic Adenocarcinoma (PAC), which constitutes more than 90% of pancreatic cancer cases, is a highly lethal malignancy, with an incidence-to-mortality ratio of 0.98. Prognosis is adversely affected by late-stage diagnosis and by biological, clinical, and pathological factors, resulting in a 5-year overall survival rate of 13.3% (SEER). Nevertheless, a subset of patients demonstrates prolonged survival, potentially due to as-yet-undetermined characteristics.

Objectives: This study aims to evaluate the sociodemographic and clinicopathological characteristics of patients with PAC treated at the National Cancer Institute (INCA), the primary cancer reference center in Brazil, and to investigate the association of these characteristics with prognostic factors in a patient subgroup.

Methods: We conducted an observational, descriptive, hospital-based cohort study with retrospective data collection (2000-2014) involving 153 PAC cases.

Results: Most of patients were females (53.6%), younger than 65 years-old (53.6%, with mean age of 62.3 ± 10.6 years), white skin color (71.0%), schooling up to 8 years (54.6%), living with someone (52.6%), having tobacco habit (51.3%) and not having alcoholic consumption (57.3%). Among smokers, we observed a high tobacco burden (47.0 ± 31.0 pack-years). There was a gradual increase in the number of cases over the years, with a predominance of case records in the last five years (2010-2014 period, 63.4%). Most patients (87.6%) had no histopathological diagnosis in the hospital registry, and the vast majority (81.0%) required restaging with a 2nd CT scan/MRI/MRC imaging, which took an average of 18 days to perform. The main anatomical topography and histopathological classification were the head of the pancreas (72.6%) and ductal type PAC (98.6%). Resectable disease (stage II, 36.2%, and stage I, 27.5%) was the most prevalent. Regarding supportive treatment, analgesia prevailed either before (75.0%) or after enrollment (87.6%). However, the need for endoscopic drainage of the biliary tract performed before (7.1%) and after (54.5%) hospital registration caught our attention. Almost half of patients (48.4%) did not receive specific oncological treatment, mainly due to an unsuitable clinical Performance Status (56.8%). Chemotherapy (53.2%) was the most common treatment in all patients. Inadequate response prevailed with disease progression (59.7%). Surgical oncological treatment, combined or not with adjuvant therapy, was the independent prognostic factor for inadequate response (OR=41.21 [95%IC:9.56-170.52], p<0,001). The median survival time was 4.04 months (95% CI: 3.09-4.99), the 5-year survival rate was 1.2%, and oncological therapy, except exclusive surgery, was the only independent prognostic factor (HR=3.52 [95%IC:1.41-8.76], p<0.01) associated with death.

Conclusions/Implications for practice or policy: In Brazil, PAC is a very lethal disease with a very low survival rate. With some sociodemographic peculiarities (age, skin color, and alcohol/tobacco habit), PAC patients get to the hospital with advanced disease and poor clinical status, preventing curative treatment and resulting in inadequate responses, with 20% of patients dying before treatment started.

Overall survival curve of Brazilian patients with pancreatic adenocarcinoma at INCA, with 60 months of follow-up (Kaplan–Meier method)